Nanda Anil, Jawahar Ajay, Sathyanarayana Satish
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Skull Base. 2003 Aug;13(3):131-138. doi: 10.1055/s-2003-43323.
The outcomes of 26 complex skull base tumors treated with microsurgery were compared with the outcomes of similar tumors treated with radiosurgery as reported in the literature. The University neurosurgery database was searched for patients who underwent microsurgery for the treatment of skull base tumors between 1990 and 2001 at Louisiana State University Health Sciences Center in Shreveport, Louisiana. Twenty-six skull base meningiomas treated by microsurgery by the senior author (AN) were identified retrospectively. On imaging, the tumors were well defined and less than 3 cm in the greatest diameter, making them ideal candidates for a radiosurgical procedure had this modality been available. The follow-up and outcomes of these 26 patients were compared with the published outcomes of similar tumors treated with radiosurgery. Total excision was achieved in 17 (65.3 %) patients. Excision was subtotal in 9 (34.6 %) patients due to the critical locations of their tumors. The median hospital stay for these patients was 4 days (range, 3 to 12 days). Two patients (7.6 %) had transient cerebrospinal fluid leaks from the wound, and 2 (7.6 %) had transient facial paresis. Overall, preoperative symptoms improved in 23 (88.4 %) patients. The median follow-up was 56 months (range, 3 to 120 months). The overall survival rate for all was 87.2 +/- 3.7 % at 50 months. Two patients (7.6 %) subsequently underwent repeat surgery for a recurrent or progressive disease. The actuarial 8-year tumor control rate was 86.4 +/- 4.4 % using the Kaplan-Meier method. For small skull base tumors with benign histology, microsurgery is as safe and effective a treatment option as stereotactic radiosurgery. The symptomatic improvement in patients is better with microsurgery than with radiosurgery because the volume of the tumor is reduced immediately. A combined approach using both modalities is usually needed for larger tumors when attempts at total resection would jeopardize the neurologic function of the patient.
将26例接受显微手术治疗的复杂颅底肿瘤的结果与文献报道的接受放射外科治疗的类似肿瘤的结果进行了比较。在路易斯安那州什里夫波特市的路易斯安那州立大学健康科学中心，检索该校神经外科数据库中1990年至2001年间接受显微手术治疗颅底肿瘤的患者。回顾性确定了由资深作者（AN）通过显微手术治疗的26例颅底脑膜瘤。影像学检查显示，肿瘤边界清晰，最大直径小于3 cm，若当时有放射外科手术这种方式，这些肿瘤将是放射外科手术的理想候选对象。将这26例患者的随访情况及结果与已发表的接受放射外科治疗的类似肿瘤的结果进行比较。17例（65.3%）患者实现了全切。9例（34.6%）患者因肿瘤位置关键而次全切除。这些患者的中位住院时间为4天（范围3至12天）。2例（7.6%）患者伤口出现短暂脑脊液漏，2例（7.6%）出现短暂面部麻痹。总体而言，23例（88.4%）患者术前症状改善。中位随访时间为56个月（范围3至120个月）。50个月时，总体生存率为87.2±3.7%。2例（7.6%）患者随后因复发或疾病进展接受了再次手术。采用Kaplan-Meier法计算的8年肿瘤控制率为86.4±4.4%。对于组织学为良性的小型颅底肿瘤，显微手术与立体定向放射外科手术一样是安全有效的治疗选择。显微手术使患者症状改善比放射外科手术更好，因为肿瘤体积立即减小。对于较大肿瘤，若全切尝试会危及患者神经功能，通常需要联合使用这两种方式。
