中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2013年
6期
608-611
,共4页
周庆九%成晓江%更·党木仁加甫%栾新平%卡合尔曼·卡德尔%付强%汪永新%刘波%柳琛
週慶九%成曉江%更·黨木仁加甫%欒新平%卡閤爾曼·卡德爾%付彊%汪永新%劉波%柳琛
주경구%성효강%경·당목인가보%란신평%잡합이만·잡덕이%부강%왕영신%류파%류침
岩斜区脑膜瘤%神经内镜%显微外科手术%颞下经小脑幕岩嵴入路
巖斜區腦膜瘤%神經內鏡%顯微外科手術%顳下經小腦幕巖嵴入路
암사구뇌막류%신경내경%현미외과수술%섭하경소뇌막암척입로
Petroclival meningioma%Neuroendoscopy%Microsurgery%Subtemporal transpetrosal-transtentorial approach
目的 探讨神经内镜辅助颞下经小脑幕岩嵴入路切除岩斜区脑膜瘤的手术方法、经验和技巧,以提高手术全切率与改善预后.方法 回顾性分析颞下经小脑幕岩嵴入路显微手术切除21例岩斜区脑膜瘤的临床资料,其中11例采用神经内镜辅助手术,对手术方法和经验进行分析和总结,并对该手术的适应证和优缺点进行分析.结果 肿瘤全切除10例(48％),次全切除8例(38％),大部切除3例(14％),术后新增脑神经损害症状或原有脑神经损害症状明显加重7例(33％),无长期昏迷及手术相关死亡病例.神经内镜辅助组手术效果优于显微镜组(P＜0.05).结论 颞下经小脑幕岩嵴入路适用于肿瘤主体在中颅窝的Ⅰ型岩斜区脑膜瘤,通过磨除岩骨,术中辅助神经内镜,有利于提高肿瘤的全切率和术后疗效.
目的 探討神經內鏡輔助顳下經小腦幕巖嵴入路切除巖斜區腦膜瘤的手術方法、經驗和技巧,以提高手術全切率與改善預後.方法 迴顧性分析顳下經小腦幕巖嵴入路顯微手術切除21例巖斜區腦膜瘤的臨床資料,其中11例採用神經內鏡輔助手術,對手術方法和經驗進行分析和總結,併對該手術的適應證和優缺點進行分析.結果 腫瘤全切除10例(48％),次全切除8例(38％),大部切除3例(14％),術後新增腦神經損害癥狀或原有腦神經損害癥狀明顯加重7例(33％),無長期昏迷及手術相關死亡病例.神經內鏡輔助組手術效果優于顯微鏡組(P＜0.05).結論 顳下經小腦幕巖嵴入路適用于腫瘤主體在中顱窩的Ⅰ型巖斜區腦膜瘤,通過磨除巖骨,術中輔助神經內鏡,有利于提高腫瘤的全切率和術後療效.
목적 탐토신경내경보조섭하경소뇌막암척입로절제암사구뇌막류적수술방법、경험화기교,이제고수술전절솔여개선예후.방법 회고성분석섭하경소뇌막암척입로현미수술절제21례암사구뇌막류적림상자료,기중11례채용신경내경보조수술,대수술방법화경험진행분석화총결,병대해수술적괄응증화우결점진행분석.결과 종류전절제10례(48％),차전절제8례(38％),대부절제3례(14％),술후신증뇌신경손해증상혹원유뇌신경손해증상명현가중7례(33％),무장기혼미급수술상관사망병례.신경내경보조조수술효과우우현미경조(P＜0.05).결론 섭하경소뇌막암척입로괄용우종류주체재중로와적Ⅰ형암사구뇌막류,통과마제암골,술중보조신경내경,유리우제고종류적전절솔화술후료효.
Objective To study the removal technique and operative experiences in the microsurgical resection of petroclival meningiomas with the subtemporal transpetrosal-transtentorial approach assisted with neuroendoscopy,and to improve the rate of total resection of tumors and the postoperative results.Methods Consecutive 21 cases of petroclival meningiomas treated from Jan.2002 to Jun.2012 by microsurgical technique using the subtemporal transpetrosal-transtentorial approach were reviewed retrospectively.Among the 21 cases,11 patients were operated with an assistance of neuroendoscopy.The tumor control rate,postoperative neurological deficit,and functional status were assessed by the Karnofsky Performance Score (KPS),and to evaluate the indications,advantages and disadvantages of this approach in assistance with neuroendoscopy.Results Gross total tumor resection was achieved in 10 patients,subtotal resection in 8 cases,and partial resection in 3 cases.New developed cranial nerves dysfunction and deterioration of original symptom after the operation were found in 7 patients.There were no deaths and longterm coma.The surgical results of patients assisted with neuroendoscopy were better than only using microscope,P ＜ 0.05.Conclusions The subtemporal transpetrosal-transtentorial approach in assistance with neuroendoscopy is suitable for petroclival meningiomas mainly in the middle fossa with extension to the posterior fossa (type Ⅰ).By resecting the petroal bone,this approach can improve the rate of total resection of tumors and the postoperative results,while decreasing the postoperative functional deficit of the cranial nerves.
