不同手术入路治疗岩斜区脑膜瘤的效果分析
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摘要
目的分析不同手术入路下治疗岩斜区脑膜瘤的效果。方法回顾性分析2012年1月至2017年12月于本院就诊的52例岩斜区脑膜瘤患者的病例资料。分别通过远外侧入路(FLA)、乙状窦后入路(RSA)、内镜下经鼻蝶入路(EEA)以及联合入路切除岩斜区不同位置的肿瘤。评估不同手术入路下肿瘤切除程度。观察手术后并发症发生情况。采用KPS评分标准评价患者术后生活质量。结果经FLA切除肿瘤14例,经RSA切除肿瘤22例,经EEA切除肿瘤10例,经EEA合并FLA/RSA切除肿瘤6例。术后平均随访22个月,乙状窦后入路即RSA肿瘤全切率高于其他手术入路,差异具有统计学意义(P <0. 05)。术后并发症发生情况方面,颅神经症状多发生于侧方入路(FLA和RSA),与其他手术入路相比,差异具有统计学意义(P <0. 05)。脑脊液漏多出现在EEA,与其他入路相比,差异具有统计学意义(P <0. 05)。其他并发症在不同手术入路术后比较,差异无统计学意义(P> 0. 05)。不同手术入路术后患者生活质量之间差异无统计学意义(P> 0. 05)。结论手术治疗岩斜区脑膜瘤,RSA根治性切除率显著高于其他入路,可有效切除体积比较大的肿瘤,适合累及全斜坡的患者,但需要注意该手术方式容易引起术后颅神经症状。
Objective To explorte the effect of different ways for treatment of durosarcoma in diagonal area by invasive surgery. Methods The clinical data of 52 patients with durosarcoma in diagonal area during January 2012 to December 2017 in this hosptial for FLA,RSA,EEA and combination microsurgical treatment were retrospectively analyzed. The excision of tumor,occurance of complications and KPS scores for life quality were assessed and compared. Results In these patients,14 cases were treated with FLA,22 cases with RSA,10 with EEA and 6 with EEA combined with FLA/RSA. Follow-up study had been conducted with average of 22 months and found complete excision ratio of RSA group is higher than other groups( P < 0. 05). The occrrence of postoperative complications in FLA and RSA is higher than other groups( P < 0. 05).And the cerebrospinal leakage mainly happen in EEA group in comparison to other groups( P < 0. 05). While the life quality of patients displayed no significant difference among these groups. Conclusion The radical resection rate of RSA is significantly higher than other approaches. RSA can effectively resect large tumors and it is appropriate to tumors with total slope involvement. But we should pay attention to RSA,in which it is easy to cause postoperative complications.
Objective To explorte the effect of different ways for treatment of durosarcoma in diagonal area by invasive surgery. Methods The clinical data of 52 patients with durosarcoma in diagonal area during January 2012 to December 2017 in this hosptial for FLA,RSA,EEA and combination microsurgical treatment were retrospectively analyzed. The excision of tumor,occurance of complications and KPS scores for life quality were assessed and compared. Results In these patients,14 cases were treated with FLA,22 cases with RSA,10 with EEA and 6 with EEA combined with FLA/RSA. Follow-up study had been conducted with average of 22 months and found complete excision ratio of RSA group is higher than other groups( P < 0. 05). The occrrence of postoperative complications in FLA and RSA is higher than other groups( P < 0. 05).And the cerebrospinal leakage mainly happen in EEA group in comparison to other groups( P < 0. 05). While the life quality of patients displayed no significant difference among these groups. Conclusion The radical resection rate of RSA is significantly higher than other approaches. RSA can effectively resect large tumors and it is appropriate to tumors with total slope involvement. But we should pay attention to RSA,in which it is easy to cause postoperative complications.
引文
[1]杨涛.两种改良颞下入路治疗岩斜区脑膜瘤的疗效分析及临床经验总结[D].大连:大连医科大学,2016.
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[6] Chanda A,Nanda A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region:an anatomic and technical study[J].Neurosurgery,2002,51(1):147-160; discussion 159-160.
[7] Iaconetta G,Fusco M,Samii M. The sphenopetroclival venous gulf:a microanatomy study[J]. J Neurosurg,2003,99(2):366-375.
[8] Kawase T. Advantages and disadvantages of surgical approaches to petroclival lesions[J]. World Neurosurg,2011,75(3-4):421.
[9] IchimumS,gawese T,Onozuka S,et al. Four subtypes of petrodival meningiomas:differences in symptoms and operative findings using the anterior transpetresal approach[J]. Acta Neurechir(Wien),2008,150(7):637-645.
[10] Maurer AJ,Safavi-Abbasi S,Cheema AA,et al. Management of petroclival meningiomas:a review of the development of current therapy[J]. J Neurol Surg B Skull Base,2014,75(5):358-367.
[11]单明,程宏伟.岩斜区脑膜瘤手术治疗进展[J].中国临床神经外科杂志,2012,17(12):764-767.
[2] Almefty R,Dunn IF,Pravdenkova S,et al. True petroclival meningiomas:results of surgical management[J]. J Neurosurg,2014,120(1):40-51.
[3] Morisako H,Goto T,Ohata K. Petroclival meningiomas resected via a combined transpetrosal approach:surgical outcomes in 60 cases and a new scoring system for clinical evaluation[J]. J Neurosurg,2015,122(2):373-380.
[4] Li D,Hao SY,Wang L,et al. Surgical management and outcomes of petroclival meningiomas:a single-center case series of 259 patients[J]. Acta Neurochir(Wien),2013,155(8):1367-1383.
[5]赵四军,赵明,徐欣,等.岩斜区脑膜瘤的手术入路选择及效果分析[J].中国实用神经疾病杂志,2017,20(2):67-69.
[6] Chanda A,Nanda A. Partial labyrinthectomy petrous apicectomy approach to the petroclival region:an anatomic and technical study[J].Neurosurgery,2002,51(1):147-160; discussion 159-160.
[7] Iaconetta G,Fusco M,Samii M. The sphenopetroclival venous gulf:a microanatomy study[J]. J Neurosurg,2003,99(2):366-375.
[8] Kawase T. Advantages and disadvantages of surgical approaches to petroclival lesions[J]. World Neurosurg,2011,75(3-4):421.
[9] IchimumS,gawese T,Onozuka S,et al. Four subtypes of petrodival meningiomas:differences in symptoms and operative findings using the anterior transpetresal approach[J]. Acta Neurechir(Wien),2008,150(7):637-645.
[10] Maurer AJ,Safavi-Abbasi S,Cheema AA,et al. Management of petroclival meningiomas:a review of the development of current therapy[J]. J Neurol Surg B Skull Base,2014,75(5):358-367.
[11]单明,程宏伟.岩斜区脑膜瘤手术治疗进展[J].中国临床神经外科杂志,2012,17(12):764-767.