Wu Zhen, Hao Shuyu, Zhang Junting, Zhang Liwei, Jia Guijun, Tang Jie, Xiao Xinru, Wang Liang, Wang Zhongcheng
Department Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China.
Surg Neurol. 2009 Oct;72(4):376-82; discussion 382. doi: 10.1016/j.surneu.2009.05.006. Epub 2009 Jul 15.
Although there has been great development in the anatomical understanding and operative techniques for skull base tumors, controversy still exists regarding the optimal surgical strategies for the FMMs. We report clinical and radiologic features as well as the surgical findings and outcome for patients with FMM treated at our institution over the last 15 years.
We reviewed 114 consecutive cases of FMM operated between May 1993 and June 2008 in the neurosurgery department at Beijing Tiantan Hospital.
There were 68 female and 46 male patients (mean age, 52.3 years; range, 28-76 years). Foramen magnum meningiomas were classified as anterior (80 cases), anterolateral (24 cases), and posterolateral (10 cases). Mean duration of symptoms was 11.7 months (ranging from 1.5 to 240 months). Cervico-occipital pain (80.7%) and headache and dizziness (42.1%) were the most common presenting symptoms. The preoperative KPS was 72.5 +/- 8.3. Mean maximum diameter of the tumors on MRI was 3.35 cm (range, 1.5-4.7 cm). Posterior midline approach was performed in 10 cases, far-lateral retrocondylar approach in 97 cases, and extended far-lateral approach in 7 cases. Gross total resection was achieved in 86.0% of patients and subtotal resection in 14.0%. Surgical mortality was 1.8%. Follow-up data were available for 93 patients, with a mean follow-up of 90.3 months (range, 1-180 months), of which 59 (63.4%) lived a normal life (KPS, 80-100).
Our experience suggests that most anterior and anterolateral FMMs can be completely resected by a far-lateral retrocondylar approach without resection of the occipital condyle. Complete resection of the tumor should be attempted at the first operation. Postoperative management of FMM is important for the prognosis.
尽管在颅底肿瘤的解剖学认识和手术技术方面取得了巨大进展，但关于枕大孔区脑膜瘤（FMMs）的最佳手术策略仍存在争议。我们报告了过去15年在我院接受治疗的FMM患者的临床和放射学特征以及手术发现和结果。
我们回顾了1993年5月至2008年6月在北京天坛医院神经外科连续手术的114例FMM病例。
有68例女性和46例男性患者（平均年龄52.3岁；范围28 - 76岁）。枕大孔区脑膜瘤分为前部（80例）、前外侧部（24例）和后外侧部（10例）。症状的平均持续时间为11.7个月（范围1.5至240个月）。颈枕部疼痛（80.7%）以及头痛和头晕（42.1%）是最常见的首发症状。术前KPS评分为72.5±8.3。MRI上肿瘤的平均最大直径为3.35 cm（范围1.5 - 4.7 cm）。10例采用后正中入路，97例采用远外侧经髁入路，7例采用扩大远外侧入路。86.0%的患者实现了肿瘤全切除，14.0%为次全切除。手术死亡率为1.8%。93例患者有随访数据，平均随访90.3个月（范围1 - 180个月），其中59例（63.4%）生活正常（KPS评分80 - 100）。
我们的经验表明，大多数前部和前外侧FMMs可通过远外侧经髁入路在不切除枕髁的情况下完全切除。应在首次手术时尝试完整切除肿瘤。FMM的术后管理对预后很重要。
