Liu Peixi, Wang Xiaowen, Liu Yingjun, Cai Jiajun, Yang Zixiao, Quan Kai, Zhu Wei, Song Jianping
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
National Center for Neurological Disorders, Fudan University, Shanghai, China.
Front Oncol. 2022 May 10;12:866225. doi: 10.3389/fonc.2022.866225. eCollection 2022.
The surgical strategy for falcotentorial junction tumors remains complex. Different approaches are selected according to the location and growth pattern of the tumor and the operator's experience. This report reviews our single-institution experience in the surgical management of falcotentorial junction tumors.
We retrospectively reviewed the clinical and imaging data, surgical strategy, and follow-up outcomes of 49 patients treated from 2007 to 2020.
All 49 patients (12 male, 37 female, mean age: 56.3 ± 11.3 years) underwent safe tumor resection. The most common complaints were headache (43%), dizziness (39%), and unstable gait (16%). Thirty percent of the tumors showed calcification, and the computed tomography scans revealed hydrocephalus in 36% of the patients. On magnetic resonance imaging, 43% of the tumors were unilateral. According to the Asari classification, the tumors were divided into inferior (16%), superior (29%), anterior (22%), and posterior (33%) types. The occipital interhemispheric approach (88%) and supracerebellar-infratentorial approach (10%) were primarily used to reach the tumors. The pathology examination results revealed that 85.7% of the tumors were meningioma and 14.3% were hemangiopericytoma. Of the 49 patients, 15 achieved a Simpson grade I resection, and 29 achieved a Simpson grade II resection. The follow-up rate was 77.6% (38/45); 94.7% of patients (36/38) achieved a favorable outcome, and 9 experienced tumor recurrences.
Surgical approach selection depends on the growth characteristics of the tumor and the degree of venous or sinus involvement. The occipital interhemispheric approach is the most commonly used and safest approach for falcotentorial junction tumors with multiple brain pressure control assistance techniques.
小脑幕切迹交界区肿瘤的手术策略仍然复杂。根据肿瘤的位置、生长方式以及术者的经验选择不同的手术入路。本报告回顾了我们单中心治疗小脑幕切迹交界区肿瘤的经验。
我们回顾性分析了2007年至2020年期间接受治疗的49例患者的临床和影像资料、手术策略及随访结果。
49例患者（男性12例，女性37例，平均年龄：56.3±11.3岁）均成功进行了肿瘤切除。最常见的症状是头痛（43%）、头晕（39%）和步态不稳（16%）。30%的肿瘤出现钙化，36%的患者计算机断层扫描显示脑积水。在磁共振成像上，43%的肿瘤为单侧性。根据浅利分类，肿瘤分为下部型（16%）、上部型（29%）、前部型（22%）和后部型（33%）。主要采用枕叶脑间沟入路（88%）和小脑上幕下入路（10%）到达肿瘤部位。病理检查结果显示，85.7%的肿瘤为脑膜瘤，14.3%为血管外皮细胞瘤。49例患者中，15例达到辛普森一级切除，29例达到辛普森二级切除。随访率为77.6%（38/45）；94.7%的患者（36/38）获得了良好的预后，9例出现肿瘤复发。
手术入路的选择取决于肿瘤的生长特点以及静脉或窦的受累程度。枕叶脑间沟入路是小脑幕切迹交界区肿瘤最常用且最安全的入路，同时可采用多种脑压控制辅助技术。
