Javed T, Sekhar L N
Department of Neurosurgery, Presbyterian-University Hospital, Pittsburgh, Pennsylvania.
Acta Neurochir Suppl (Wien). 1991;53:171-82. doi: 10.1007/978-3-7091-9183-5_28.
The surgical management of intradural clival tumours is difficult due to the relative inaccessibility of the clivus through traditional neurosurgical approaches, and the intimate relationship of such tumours to critical neurovascular and brainstem structures. This report concentrates on the experience with clival meningiomas, which are the most common intradural clival tumours. Between July 1983 and July 1990, 52 patients with petroclival meningiomas underwent surgical excision of their tumours. A variety of skull base approaches were utilized to obtain wide tumour exposure with minimal brain retraction. Large or giant tumours required multiple approaches and staged removal of tumour. Tumour resection was evaluated by a standard protocol of postoperative MR or CT scans. Total tumour resection was achieved in 38 cases (73%), subtotal resection in 11 (21%) and partial resection in 3 (6%). Follow-up has ranged from 4 to 83 months. Two patients had recurrence of tumour requiring re-operation with one receiving additional external beam radiation. Two postoperative deaths occurred, one from pneumonia and another from infectious complications. The most common postoperative morbidity were lower cranial nerve palsy, aspiration peumonia and temporary hemiparesis.
由于通过传统神经外科手术方法难以接近斜坡，且此类肿瘤与关键神经血管和脑干结构关系密切，因此硬膜内斜坡肿瘤的手术治疗具有挑战性。本报告重点介绍斜坡脑膜瘤的治疗经验，斜坡脑膜瘤是最常见的硬膜内斜坡肿瘤。1983年7月至1990年7月，52例岩斜脑膜瘤患者接受了肿瘤手术切除。采用了多种颅底入路，以在尽量减少脑牵拉的情况下广泛暴露肿瘤。大型或巨大肿瘤需要多种入路并分期切除肿瘤。通过术后磁共振成像（MR）或计算机断层扫描（CT）的标准方案评估肿瘤切除情况。38例（73%）实现了肿瘤全切除，11例（21%）次全切除，3例（6%）部分切除。随访时间为4至83个月。2例患者肿瘤复发需要再次手术，其中1例接受了额外的外照射放疗。发生了2例术后死亡，1例死于肺炎，另1例死于感染性并发症。最常见的术后并发症是低位颅神经麻痹、吸入性肺炎和暂时性偏瘫。
