Qiu Bo, Wang Yong, Ou Shaowu, Guo Zongze, Wang Yunjie
Department of Neurosurgery, the First Affiliated Hospital of China Medical University , Shenyang, Liaoning , P.R. China.
Int J Neurosci. 2014 Oct;124(10):741-7. doi: 10.3109/00207454.2013.878341. Epub 2014 Feb 7.
In the current study, we reviewed and re-evaluated the experiences of microsurgical management for pineal region meningiomas via the unilateral occipital transtentorial approach (Poppen's approach). Clinical data were obtained on 15 meningiomas of the pineal region, which underwent microsurgery via unilateral Poppen's approach from March 2009 to June 2012. These patients were hospitalized in our department; their data were collected and analyzed retrospectively. The tumors were removed via the right Poppen's approach in 12 cases and left Poppen's approach in 3 cases, and intraoperative external ventricular drainage was performed for hydrocephalus in 3 cases. As a result, gross total resection was achieved in 11 cases, near total resection in 3 cases and subtotal resection in 1 case. All resected tumors were pathologically confirmed. The postoperative complications included two cases of homonymous hemianopia, and deteriorated Parinaud syndrome and diplopia in one case. Ten cases were followed up (range 1-4 years) and no death occurred. On the basis of the existing literature and our experiences, the unilateral Poppen's approach is appropriate for most meningiomas of the pineal region that are small or intermediate in size. However, gross total resection might be difficult via the unilateral Poppen's approach for large-sized meningiomas with much contralateral infratentorial extension due to limited exposure. For these cases, combined supra-infratentorial or bilateral Poppen's approaches are recommended. Preoperative or intraoperative external ventricular drainage can increase tumor exposure and improve microsurgical effects.
在本研究中，我们回顾并重新评估了经单侧枕下入幕（Poppen入路）显微手术治疗松果体区脑膜瘤的经验。获取了2009年3月至2012年6月期间经单侧Poppen入路接受显微手术的15例松果体区脑膜瘤的临床资料。这些患者均在我科住院，其数据进行回顾性收集和分析。肿瘤经右侧Poppen入路切除12例，经左侧Poppen入路切除3例，3例因脑积水行术中脑室外引流。结果，11例实现了全切除，3例近全切除，1例次全切除。所有切除的肿瘤均经病理证实。术后并发症包括2例同向性偏盲，1例Parinaud综合征加重和复视。10例进行了随访（随访时间1 - 4年），无死亡病例。基于现有文献和我们的经验，单侧Poppen入路适用于大多数体积小或中等大小的松果体区脑膜瘤。然而，对于因暴露受限而向对侧幕下广泛延伸的大型脑膜瘤，经单侧Poppen入路可能难以实现全切除。对于这些病例，建议采用幕上 - 幕下联合或双侧Poppen入路。术前或术中脑室外引流可增加肿瘤暴露并提高显微手术效果。
