Department of Neurological Surgery, Brain Tumor Research Center, University of California at San Francisco, San Francisco, CA 94143, USA.
J Clin Neurosci. 2011 Jun;18(6):755-9. doi: 10.1016/j.jocn.2010.09.023. Epub 2011 Apr 19.
We retrospectively reviewed 24 patients with cerebellopontine angle (CPA) meningioma from our institution to describe the clinical and surgical significance of extensions into the internal auditory canal (IAC). Of these patients, 62% had invasion of the IAC, which was associated with high rates of unilateral hearing loss at presentation (67% versus [vs.] 22%, p<0.05). A retrosigmoid approach was used in 22/24 patients, of whom 13 had an IAC extension. In five patients, IAC drilling was needed to achieve a more complete resection and 20 patients of the 22 (91%) had improved or stable hearing postoperatively, and one patient had permanent facial paralysis. Cranial nerve IX and X were the most common complications (17% and 33% respectively), and were almost exclusively associated with resection of tumor extensions into the jugular foramen (p<0.01). We conclude that CPA meningiomas can be removed with excellent rates of hearing and facial nerve preservation. Caution must be used when attempting to resect tumor extensions into the jugular foramen given the high rates of lower CN complications.
我们回顾性分析了来自本机构的 24 例桥小脑角（CPA）脑膜瘤患者的临床资料，旨在阐述肿瘤向内听道（IAC）延伸的临床和手术意义。这些患者中，62%存在 IAC 受侵，其术前单侧听力丧失发生率较高（67%比[vs.]22%，p<0.05）。24 例患者中，22 例行乙状窦后入路，其中 13 例 IAC 受侵。5 例患者需磨除 IAC 以实现更完全的切除，22 例患者中 20 例（91%）术后听力改善或稳定，1 例患者出现永久性面瘫。颅神经 IX 和 X 是最常见的并发症（分别为 17%和 33%），且几乎均与切除累及颈静脉孔的肿瘤延伸部分相关（p<0.01）。我们得出结论，CPA 脑膜瘤可通过手术获得极佳的听力和面神经保留率。鉴于颅神经 IX 和 X 并发症发生率较高，在试图切除累及颈静脉孔的肿瘤延伸部分时需谨慎操作。
