Bydon Mohamad, Martin Ma Ting, Xu Risheng, Weingart Jon, Olivi Alessandro, Gokaslan Ziya L, Tamargo Rafael J, Brem Henry, Bydon Ali
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Spinal Column Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA; Graduate Program of Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Clin Neurol Neurosurg. 2014 Feb;117:71-79. doi: 10.1016/j.clineuro.2013.11.023. Epub 2013 Dec 7.
We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes.
We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012.
There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior midline suboccipital approach (9 cases), the far lateral approach (12 cases) and the lateral retrosigmoid approach (1 case). Gross-total resection was achieved in 45% of patients and subtotal in 55%. The most common post-operative complications were cranial nerve (CN) IX and X deficits. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, spinocranial tumors were detected at a smaller size (p=0.0724) and treated earlier (p=0.1398) than craniospinal tumors. They were associated with a higher rate of total resection (p=0.0007), fewer post-operative CN IX or X deficits (p=0.0053), and shorter hospitalizations (p=0.08).
Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.
我们介绍在处理颅颈交界区脑膜瘤方面的经验，并讨论各种手术方法及结果。
我们回顾性分析了1995年8月至2012年5月间连续手术的22例颅颈交界区脑膜瘤病例。
患者中女性15例，男性7例（平均年龄54岁）。脑膜瘤根据起源分为脊髓颅型（7例）或颅脊髓型（15例）。此外，肿瘤根据相对于脑干或脊髓的解剖位置进行划分：前位肿瘤2例，前外侧7例，外侧12例，后外侧1例。手术方法包括后正中枕下入路（9例）、远外侧入路（12例）和外侧乙状窦后入路（1例）。45%的患者实现了全切，55%为次全切。最常见的术后并发症是Ⅸ、Ⅹ颅神经功能缺损。死亡率为4.5%。迄今为止无复发，平均随访46.5个月，末次随访时平均卡氏评分82.3。在本系列中，脊髓颅型肿瘤比颅脊髓型肿瘤发现时体积更小（p = 0.0724）且治疗更早（p = 0.1398）。它们与更高的全切率（p = 0.0007）、更少的术后Ⅸ或Ⅹ颅神经功能缺损（p = 0.0053）以及更短的住院时间（p = 0.08）相关。
我们的经验表明，后正中枕下或远外侧入路，同时尽量减少髁突钻孔和椎动脉移位，适用于本系列中的大多数病例。
