Burks Joshua D, Conner Andrew K, Bonney Phillip A, Archer Jacob B, Christensen Blake, Smith Jacqueline, Safavi-Abbasi Sam, Sughrue Michael
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Department of Neurosurgery, Indiana University School of Medicine.
Cureus. 2016 Apr 27;8(4):e588. doi: 10.7759/cureus.588.
Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas.
Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II.
The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed.
With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results.
锁孔开颅术越来越多地用于颅底病变。在此，我们回顾我们近期使用这些方法切除颅内脑膜瘤的经验。
收集了2012年1月至2013年6月资深作者采用锁孔入路治疗的所有患者的临床和手术数据。27例患者共切除31例脑膜瘤，包括幕上9例、前颅窝5例、中颅窝7例、后颅窝6例和复杂颅底肿瘤4例。29例肿瘤为世界卫生组织I级，2例为II级。
颅底肿瘤的平均手术时间为8小时22分钟（范围：2:55 - 16:14），幕上肿瘤为4小时27分钟（范围：1:45 - 7:13）。辛普森切除分级如下：I级 = 8例，II级 = 8例，III级 = 1例，IV级 = 15例，V级 = 0例。术后中位住院时间为4天（范围：1 - 20天）。在9例有一定程度视力丧失的患者中，7例视力改善或完全恢复。在6例有脑神经麻痹的患者中，4例术后神经功能缺损改善或消失。4例患者出现新的神经功能缺损，所有这些在最后一次随访时均得到改善或消失。讨论了这些方法在颅内脑膜瘤治疗中的技术要点和手术细微差别。
通过仔细的术前评估，锁孔入路可单独或联合使用，以治疗各种部位的脑膜瘤，效果满意。
