Kankane Vivek Kumar, Misra Basant Kumar
Department of Neurosurgery, G.R. Medical College, JAH Groups of Hospital, Gwalior, Madhya Pradesh, India.
Department Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2021 Feb 23;16(1):89-95. doi: 10.4103/ajns.AJNS_357_20. eCollection 2021 Jan-Mar.
Petroclival meningioma (PCM) is considered among the most difficult tumors to be treated by microneurosurgery because of its location and its relation to critical structures. The authors report on the outcome in a series of patients with PCM treated in the new millennium with a tailored approach of gross total excision or subtotal removal and adjuvant Gamma Knife Radiosurgery (GKR) depending on the particular case.
Between 2001 and 2017, 72 consecutive PCMs were operated in a single center by the senior surgeon. Clinical presentation, operative approaches, intraoperative findings, complications, and imaging findings were retrospectively analyzed. Postoperative outcome, adjuvant Gamma knife, and follow-up findings were reviewed.
The average age was 47.95 years, and female-to-male ratio was 52:20. Cavernous sinus extension was present in 21 patients. The mean duration of follow-up was 66.65 months. Gross-total resection, near-total resection (NTR), and subtotal resection (STR) resection was achieved in 30, 24, and 18 (42.8%, 34.28%, and 25%) patients, respectively, with recurrences of 10%, 33%, and 50%, respectively. Twenty-two patients (18 STR and 4 NTR) had received postoperative GKR. Only four patients had recurrences following GKR. New cranial nerve deficits were more common in patients in whom a total resection was performed. There was no mortality.
Gross total excision had the best recurrence free rate though with a higher morbidity. Upfront GKR is advisable in patients with residual tumor, if the preoperative temporal course had a rapid symptomatology, to reduce recurrence. Wait and watch for a small intracavernous residue and radiosurgery on growth is also a valid option as long as follow-up is not suspect. A flexible approach of individualizing the treatment protocol for a given patient goes a long way toward optimal outcome.
岩斜区脑膜瘤（PCM）因其位置及与重要结构的关系，被认为是显微神经外科最难治疗的肿瘤之一。作者报告了新千年以来一系列采用根据具体病例量身定制的全切除或次全切除及辅助伽玛刀放射外科（GKR）方法治疗的PCM患者的治疗结果。
2001年至2017年期间，由资深外科医生在单一中心连续对72例PCM进行手术。对临床表现、手术入路、术中发现、并发症及影像学检查结果进行回顾性分析。对术后结果、辅助伽玛刀治疗及随访结果进行评估。
平均年龄47.95岁，女性与男性比例为52:20。21例患者存在海绵窦侵犯。平均随访时间为66.65个月。分别有30例（42.8%）、24例（34.28%）和18例（25%）患者实现了全切除、近全切除（NTR）和次全切除（STR），复发率分别为10%、33%和50%。22例患者（18例STR和4例NTR）接受了术后GKR。GKR后仅有4例患者复发。全切除患者出现新的颅神经功能缺损更为常见。无死亡病例。
全切除的无复发率最佳，尽管并发症发生率较高。对于残留肿瘤患者，如果术前病程症状进展迅速，术前进行GKR以降低复发是可取的。对于小的海绵窦内残留，只要随访无可疑情况，观察等待并在肿瘤生长时进行放射外科治疗也是一种有效的选择。针对特定患者灵活制定个体化治疗方案对实现最佳治疗效果大有帮助。
