Mathiesen Tiit, Gerlich Asa, Kihlström Lars, Svensson Mikael, Bagger-Sjöbäck Dan
Neurosurgery Section, Institute of Clinical Neuroscience, Karolinska University Hospital, Solna, Stockholm, Sweden.
Neurosurgery. 2007 Jun;60(6):982-91; discussion 991-2. doi: 10.1227/01.NEU.0000255476.06247.F1.
Surgical treatment may be required for large petroclival meningiomas; however, surgery for these lesions is a major undertaking, and modern surgical approaches are still associated with considerable morbidity and recurrence rates. We analyzed our series of transpetrosally operated petroclival meningiomas to obtain detailed information regarding the surgery outcomes with respect to facial nerve effects, hearing changes, general neurological and psychosocial differences, and recurrence rates to identify opportunities for improvement.
Between 1994 and 2004, we used transpetrosal approaches to operate on 29 patients for petroclival meningiomas larger than 30 mm. All patients were analyzed in detail regarding neurological outcomes and hearing abilities after surgery. Swedish-speaking patients were contacted for a psychosocial follow-up evaluation using the short-item 36 (SF-36) form.
After surgery, the Glasgow Outcome Score improved in 14 patients, was unchanged in 11 patients, and worsened in four patients. Facial nerve function was found to be of House-Brackmann Grade 3 or worse in six patients (including three individuals with transcochlear surgery and facial nerve rerouting). Of the 23 patients who underwent hearing-preservation surgery, serviceable hearing was preserved in 17 individuals. Nineteen Swedish patients were contacted for psychosocial evaluation. Three patients could not participate for health reasons; of the remaining 16 patients, 12 reported physical health scores that were below mean values for the general population. For patients who did not experience very serious neurological compromise, we found that unexpected painful trigeminal neuropathy and unilateral swallowing difficulties conveyed a negative influence on health. Three years after surgery, the patients reported more normalized health scores.
Generally, outcomes compared well with current reports. Outcomes can be improved, however by improving patients' psychosocial support; striving to decompress, preserve, and minimize dissection of ill-defined planes of cranial nerves; and using Simpson Grade 4 gamma knife approaches when radicality is precluded. Currently, the performance of transpetrosal surgery for petroclival meningiomas is a major undertaking that significantly affects a patient's health for several years; however, the approaches that we used allowed a high degree of tumor control with relatively little neurological morbidity.
大型岩斜区脑膜瘤可能需要手术治疗；然而，针对这些病变的手术是一项重大任务，并且现代手术方法仍伴有相当高的发病率和复发率。我们分析了一系列经岩骨入路手术的岩斜区脑膜瘤病例，以获取有关手术结果的详细信息，包括面神经影响、听力变化、一般神经功能和心理社会差异以及复发率，从而确定改进的机会。
1994年至2004年间，我们采用经岩骨入路对29例岩斜区脑膜瘤直径大于30mm的患者进行手术。对所有患者术后的神经功能结果和听力能力进行了详细分析。使用简短36项健康调查量表（SF - 36）对说瑞典语的患者进行心理社会随访评估。
术后，14例患者格拉斯哥预后评分改善，11例患者评分不变，4例患者评分恶化。6例患者（包括3例行经耳蜗手术及面神经改道的患者）面神经功能为House - Brackmann 3级或更差。在23例行听力保留手术的患者中，17例患者保留了有用听力。联系了19例瑞典患者进行心理社会评估。3例患者因健康原因无法参与；在其余16例患者中，12例报告的身体健康评分低于一般人群的平均值。对于未经历非常严重神经功能损害的患者，我们发现意外的疼痛性三叉神经病变和单侧吞咽困难对健康有负面影响。术后三年，患者报告的健康评分更为正常。
总体而言，结果与当前报告相比良好。然而，通过改善患者的心理社会支持；努力对颅神经界限不清的平面进行减压、保留并尽量减少解剖；以及在无法进行根治性手术时采用辛普森4级伽玛刀治疗，可以改善结果。目前，经岩骨手术治疗岩斜区脑膜瘤是一项重大任务，会在数年时间里显著影响患者健康；然而，我们使用的方法在神经功能发病率相对较低的情况下实现了高度的肿瘤控制。
