中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2012年
8期
783-787
,共5页
吴震%李达%郝淑煜%王亮%林久銮%汤劼%肖新如%贾桂军%张力伟%张俊廷
吳震%李達%郝淑煜%王亮%林久鑾%湯劼%肖新如%賈桂軍%張力偉%張俊廷
오진%리체%학숙욱%왕량%림구란%탕할%초신여%가계군%장력위%장준정
脑膜瘤%岩斜区%乙状窦前入路%颞下入路%分型
腦膜瘤%巖斜區%乙狀竇前入路%顳下入路%分型
뇌막류%암사구%을상두전입로%섭하입로%분형
Meningioma%Petroclival%Presigmoid approach%Subtemporal approach%Classification
目的 分析岩斜区脑膜瘤影像学分型及手术入路选择.方法 回顾分析318例岩斜区脑膜瘤临床资料,将其分为岩尖型、海绵窦型、蝶岩型、岩斜型、岩斜海绵窦型、CPA型、斜坡型和广泛型,根据分型选择手术入路.结果 入组248例,术前KPS评分73.7±10.3.主要入路包括乙状窦前入路(49.6％),颞下经岩经小脑幕入路/岩前Kawase入路(STTA/KA) (35.1％).全切(SimpsonⅠ、Ⅱ级)52.4％.前3型主要入路为STTA/KA (53.7％),而后5型则为乙状窦前入路(63.8％),差异有统计学意义(x2=27.461,P＜0.001).乙状窦前入路的第Ⅵ、Ⅶ和Ⅷ脑神经并发症率较STTA/KA高.随访KPS评分为75.8±26.9,较术前差异无统计学意义(t=- 1.321,P=0.188),改善57.7％,稳定19.0％.结论 岩斜脑膜瘤分型有利于手术入路的选择,STTA/KA入路适于前3型,而乙状窦前入路则适于后5型,但仍需术前全面评估,实现个体化治疗,以达到最佳预后.
目的 分析巖斜區腦膜瘤影像學分型及手術入路選擇.方法 迴顧分析318例巖斜區腦膜瘤臨床資料,將其分為巖尖型、海綿竇型、蝶巖型、巖斜型、巖斜海綿竇型、CPA型、斜坡型和廣汎型,根據分型選擇手術入路.結果 入組248例,術前KPS評分73.7±10.3.主要入路包括乙狀竇前入路(49.6％),顳下經巖經小腦幕入路/巖前Kawase入路(STTA/KA) (35.1％).全切(SimpsonⅠ、Ⅱ級)52.4％.前3型主要入路為STTA/KA (53.7％),而後5型則為乙狀竇前入路(63.8％),差異有統計學意義(x2=27.461,P＜0.001).乙狀竇前入路的第Ⅵ、Ⅶ和Ⅷ腦神經併髮癥率較STTA/KA高.隨訪KPS評分為75.8±26.9,較術前差異無統計學意義(t=- 1.321,P=0.188),改善57.7％,穩定19.0％.結論 巖斜腦膜瘤分型有利于手術入路的選擇,STTA/KA入路適于前3型,而乙狀竇前入路則適于後5型,但仍需術前全麵評估,實現箇體化治療,以達到最佳預後.
목적 분석암사구뇌막류영상학분형급수술입로선택.방법 회고분석318례암사구뇌막류림상자료,장기분위암첨형、해면두형、접암형、암사형、암사해면두형、CPA형、사파형화엄범형,근거분형선택수술입로.결과 입조248례,술전KPS평분73.7±10.3.주요입로포괄을상두전입로(49.6％),섭하경암경소뇌막입로/암전Kawase입로(STTA/KA) (35.1％).전절(SimpsonⅠ、Ⅱ급)52.4％.전3형주요입로위STTA/KA (53.7％),이후5형칙위을상두전입로(63.8％),차이유통계학의의(x2=27.461,P＜0.001).을상두전입로적제Ⅵ、Ⅶ화Ⅷ뇌신경병발증솔교STTA/KA고.수방KPS평분위75.8±26.9,교술전차이무통계학의의(t=- 1.321,P=0.188),개선57.7％,은정19.0％.결론 암사뇌막류분형유리우수술입로적선택,STTA/KA입로괄우전3형,이을상두전입로칙괄우후5형,단잉수술전전면평고,실현개체화치료,이체도최가예후.
Objective To analyze the classification of petroclival meningiomas according to the tumor extension on magnetic resonance imaging ( MRI ) and choice of surgical approach.Methods The clinical data of 318 cases of petroclival meningiomas were retrospectively analyzed.The cases were classified into eight types:petrous apex,cavernous sinus,sphenopetrosal,petroclival,petroclival - cavernous sinus,cerebellopontine angle (CPA),clival and extensive types.The pre- and post -operative statuses were evaluated by Karnofsky Performance Scale (KPS).Results 248 patients were included in the study with a mean preoperative KPS of 73.7 ± 10.3. The most frequent approaches were presigmoid transpetrosal approach (49.6％) followed with subtemporal transpetrosal and transtentorial approach/ Kawase' s approach (STTA/KA) (35.1％ ).Complete resection (Simpson Grade Ⅰ or Ⅱ ) was achieved in 52.4％ patients.The most frequent approach of the first three types was STTA/KA ( 53.7％ ) and presigmoid transpetrosal approach (63.8％) in the latter five types,and the different proportion of approaches used between the two groups was significant (x2 =27.461,P ＜ 0.001 ).The complication rate of cranial nerves Ⅵ,Ⅶ and Ⅷ of presigmoid transpetrosal approach was higher than that of STTA/KA.The recent KPS was 75.8 ±26.9 without statistical difference from preoperative KPS (t =- 1.321,P =0.188 ).Compared with preoperative status,57.7％ patients were improved and 19.0％ were stabilized at recent evaluation.Conclusions Classification of petroclival meningiomas will contribute to the approach selection.STTA/KA approach is fit for the first three types,meanwhile,presigmoid transpetrosal approach is suitable for the latter five types. Comprehensive preoperative evaluation is essential to achieve individualized treatment and favorable prognosis.
