Du W, Zhong D, Lü D, Li J, Huang H Y, Yang J, Wu Y T, Xia H J, Tang W Y, Sun X C
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Zhonghua Yi Xue Za Zhi. 2018 May 8;98(17):1317-1321. doi: 10.3760/cma.j.issn.0376-2491.2018.17.007.
To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas. From January 2011 to December 2016, a cohort of 28 patients with medial tentorial meningiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University. Patients who treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group, and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group. The surgical approaches tailored in our patients were based on predominant direction of tumor extension. The extent of tumor resection was scored according to the Simpson's classification scale. Comparisons of tumor size, operation time, hospitalization time, retraction-related injury, tumor Simpson resection grade and Karnofsky Performance Scale(KPS) score six months after surgery were also made between two groups. A total of 12 patients(retractor group) were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group). The difference between two groups with regard to sex, age, tumor size, operation time and tumor Simpson resection grade was not statistically significant(all >0.05). The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3 d±1.8 d vs 20.2 d±1.3 d, =0.004). The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group(1/16 vs 6/12), =0.022]. The dynamic retraction group had better neurological recovery rate with KPS >80 evaluated six months after surgery compared with the retractor group(14/16 vs 5/12, =0.017). Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible, which can obviate or reduce the amount of brain retraction needed, and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.
探讨动态牵开显微神经外科手术治疗小脑幕内侧脑膜瘤的有效性及临床意义。2011年1月至2016年12月，重庆医科大学附属第一医院对28例小脑幕内侧脑膜瘤患者进行了显微神经外科手术治疗。将2014年1月至2016年12月术中采用动态牵开手术治疗的患者纳入动态牵开组，将2011年1月至2013年12月术中使用固定牵开器的患者纳入牵开器组。根据肿瘤主要扩展方向为患者量身定制手术入路。肿瘤切除范围根据辛普森分级量表进行评分。同时比较两组患者的肿瘤大小、手术时间、住院时间、牵开相关损伤、肿瘤辛普森切除分级及术后6个月的卡氏功能状态评分（KPS）。术中共有12例患者（牵开器组）使用了自持式脑牵开器，16例患者（动态牵开组）采用了动态牵开手术。两组在性别、年龄、肿瘤大小、手术时间及肿瘤辛普森切除分级方面差异无统计学意义（均>0.05）。动态牵开组的平均住院时间短于牵开器组（18.3 d±1.8 d对20.2 d±1.3 d，P=0.004）。与牵开器组相比，动态牵开组牵开相关损伤的发生率较低（1/16对6/12，P=0.022）。与牵开器组相比，动态牵开组术后6个月KPS>80的神经功能恢复率更好（14/16对5/12，P=0.017）。动态牵开显微神经外科手术治疗小脑幕内侧脑膜瘤是可行的，可避免或减少所需的脑牵开量，有助于降低术后神经功能缺损和并发症的风险，减少住院费用并改善手术效果。
