Koutourousiou Maria, Fernandez-Miranda Juan C, Vaz-Guimaraes Filho Francisco, de Almeida John R, Wang Eric W, Snyderman Carl H, Gardner Paul A
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2017 Mar;99:500-517. doi: 10.1016/j.wneu.2016.12.001. Epub 2016 Dec 10.
Transpetrosal approaches for the treatment of petroclival meningiomas are often associated with substantial morbidity and long recovery. With the goal of early clinical improvement, we have used less invasive surgical approaches for petroclival meningiomas.
We retrospectively reviewed 32 patients with petroclival meningiomas. Eleven patients (34.4%) were managed with lateral approaches (retrosigmoid or far lateral approach), 17 (53.1%) with anterior midline approaches (endoscopic endonasal approach [EEA]), and 4 (12.5%) with a combination.
The average Karnofsky Performance Score (KPS) at presentation was 73.8. The average postoperative KPS improved to 87.9 (P < 0.001) during short-term follow-up of 14 months (range, 1-42) and was significantly higher in primary tumors (P = 0.013), tumors <4 cm (P = 0.039), and tumors without vascular encasement (P = 0.002) but remained significant regardless of age, tumor size, or vascular encasement. The greatest benefit occurred with primary tumors, in young patients and in those who underwent nontotal resection (P < 0.001). EEA had a significantly greater potential for improved KPS (P = 0.002). Gross (n = 6) or near total (n = 9) resection was achieved in 15 of 32 cases (47%). Complications included new cranial nerve palsies affecting mainly the abducens nerve (18.7%). New lower cranial nerve palsies occurred in only 1 case (3.1%). Other complications included postoperative hydrocephalus (15.6%) and cerebrospinal fluid leak (28.1%). One patient died in the perioperative period (3.1%).
In the short-term, less aggressive cranial base approaches, including retrosigmoid exposures and the recently introduced EEA, are effective alternatives to transpetrosal approaches for debulking petroclival meningiomas with significant early clinical improvement and limited major surgical complications.
经岩骨入路治疗岩斜区脑膜瘤常伴有较高的发病率和较长的恢复时间。为了实现早期临床改善，我们采用了侵入性较小的手术方法治疗岩斜区脑膜瘤。
我们回顾性分析了32例岩斜区脑膜瘤患者。11例（34.4%）采用外侧入路（乙状窦后入路或远外侧入路），17例（53.1%）采用前正中入路（内镜鼻内入路[EEA]），4例（12.5%）采用联合入路。
就诊时平均卡氏功能状态评分（KPS）为73.8。在14个月（范围1 - 42个月）的短期随访中，术后平均KPS提高到87.9（P < 0.001），在原发性肿瘤（P = 0.013）、肿瘤<4 cm（P = 0.039）和无血管包绕的肿瘤（P = 0.002）中显著更高，但无论年龄、肿瘤大小或血管包绕情况如何均有显著提高。最大的获益出现在原发性肿瘤、年轻患者和接受非全切除的患者中（P < 0.001）。EEA在改善KPS方面具有显著更大的潜力（P = 0.002）。32例中有15例（47%）实现了大体（n = 6）或近全切除（n = 9）。并发症包括主要影响展神经的新发脑神经麻痹（18.7%）。仅1例（3.1%）出现新的低位脑神经麻痹。其他并发症包括术后脑积水（15.6%）和脑脊液漏（28.1%）。1例患者在围手术期死亡（3.1%）。
短期内，侵袭性较小的颅底入路，包括乙状窦后显露和最近引入的EEA，是经岩骨入路的有效替代方法，用于切除岩斜区脑膜瘤，可实现显著的早期临床改善且主要手术并发症有限。
