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岩斜脑膜瘤：一种有助于选择手术入路的简单系统。

Petroclival Meningiomas: A Simple System That Could Help in Selecting the Approach.

机构信息

Committee of Neurosurgery in the Universidad Nacional Autónoma de México, Mexico City, Mexico.

Centro Médico ABC, Mexico City, Mexico.

出版信息

Oper Neurosurg (Hagerstown). 2021 Sep 15;21(4):225-234. doi: 10.1093/ons/opab224.

DOI:10.1093/ons/opab224
PMID:34293125
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8440063/
Abstract

BACKGROUND

Petroclival meningiomas (PCM) represent a neurosurgical challenge due to their strategic location close to the brainstem.

OBJECTIVE

To assess the applicability of a retrosigmoid approach (RSA) by analyzing the degree of displacement of the middle cerebellar peduncle (MCP) elicited by PCM.

METHODS

Patients with PCM were prospectively included and divided into those whose imaging studies showed that the posterior end of the MCP was displaced by the tumor and were eligible for and underwent RSA (group A) and those who were not eligible for RSA and who underwent surgery via a posterior transpetrosal approach (group B). We compared tumor behavior, clinical characteristic of patients and surgical results.

RESULTS

Twenty patients with PCM were enrolled and allocated to group A (n = 15) or group B (n = 5). The clinical manifestations were more severe in group B; tumors in this group were larger and gross total removal was achieved in only 1 patient (20%). In comparison, in 12 cases on group A, tumors could be totally removed (80%) and all of these patients could recover their quality of life after surgery.

CONCLUSION

To our knowledge, this study is the first to consider displacement of the MCP when establishing a suitable surgical approach for PCM. Our results suggest that the RSA becomes increasingly suitable when peduncle displacement is greater. By using this method, it was also possible to identify two types of tumors: petroclivals (group A) and clivopetrosals (group B), that show some specific clinical and surgical differences.

摘要

背景

岩斜脑膜瘤（PCM）由于其靠近脑干的战略位置，是神经外科的一个挑战。

目的

通过分析 PCM 引起的小脑脑桥脚（MCP）的移位程度，评估经乙状窦后入路（RSA）的适用性。

方法

前瞻性纳入 PCM 患者，并根据 MCP 的后末端是否被肿瘤移位，将其分为符合且接受 RSA 治疗的 A 组（n=15）和不符合 RSA 适应证而行经岩后入路治疗的 B 组（n=5）。我们比较了两组肿瘤行为、患者的临床特征和手术结果。

结果

共纳入 20 例 PCM 患者，分配至 A 组（n=15）或 B 组（n=5）。B 组患者的临床表现更严重；肿瘤更大，仅 1 例（20%）实现大体全切除。相比之下，A 组的 12 例肿瘤可完全切除（80%），所有患者术后生活质量均可恢复。

结论

据我们所知，这项研究首次考虑了 MCP 的移位，以确定治疗 PCM 的合适手术入路。我们的结果表明，当 peduncle 移位较大时，RSA 变得越来越适用。通过使用这种方法，还可以识别两种类型的肿瘤：岩斜部（A 组）和岩斜坡部（B 组），它们具有一些特定的临床和手术差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/bc57bd664031/opab224fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/183b353eca02/opab224fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/d33efb788f43/opab224fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/98bac81ccec7/opab224fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/6651a466ba2b/opab224fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/9c8f0b5dd17e/opab224fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/bc57bd664031/opab224fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/183b353eca02/opab224fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/d33efb788f43/opab224fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/98bac81ccec7/opab224fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/6651a466ba2b/opab224fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/9c8f0b5dd17e/opab224fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79c0/8440063/bc57bd664031/opab224fig6.jpg

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Clinical outcomes and survival analysis for petroclival meningioma patients receiving surgical resection: an analysis of 176 cases.接受手术切除的岩斜区脑膜瘤患者的临床结果及生存分析：176例病例分析
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