Wu Pengfei, Guan Yanlei, Wang Minghao, Zhang Luyang, Zhao Dan, Cui Xiao, Liu Jiyuan, Qiu Bo, Tao Jun, Wang Yunjie, Ou Shaowu
Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110001, Liaoning, China.
Chin Neurosurg J. 2023 Jan 24;9(1):3. doi: 10.1186/s41016-022-00315-y.
To investigate the classification and microsurgical treatment of foramen magnum meningioma (FMM).
We retrospectively analyzed 76 patients with FMM and classified them into two classifications, classification ABS according to the relationship between the FMM and the brainstem and classification SIM according to the relationship between the FMM and the vertebral artery (VA). All patients underwent either the far lateral approach (54 cases) or the suboccipital midline approach (22 cases).
Of the 76 cases, 47 cases were located ahead of the brainstem (A), 16 cases at the back of the brainstem (B), and 13 cases were located laterally to the brainstem (S). There were 15 cases located superior to the VA (S), 49 cases were inferior (I), and 12 cases were mixed type (M). Among 76 cases, 71 cases were resected with Simpson grade 2 (93.42%), 3 with Simpson grade 3 (3.95%), and 2 with Simpson grade 4 (2.63%). We summarized four anatomical triangles: triangles SOT, VOT, JVV, and TVV. The mean postoperative Karnofsky performance score was improved in all patients (p < 0.05). However, several complications occurred, including hoarseness and CSF leak.
ABS and SIM classifications are objective indices for choosing the surgical approach and predicting the difficulty of FMMs, and it is of great importance to master the content, position relationship with the tumor, and variable anatomical structures in the four "triangles" for the success of the operation.
探讨枕骨大孔脑膜瘤（FMM）的分类及显微外科治疗。
回顾性分析76例FMM患者，根据FMM与脑干的关系将其分为ABS分类，根据FMM与椎动脉（VA）的关系分为SIM分类。所有患者均采用远外侧入路（54例）或枕下中线入路（22例）。
76例中，47例位于脑干前方（A），16例位于脑干后方（B），13例位于脑干外侧（S）。15例位于VA上方（S），49例位于下方（I），12例为混合型（M）。76例中，71例按辛普森分级为2级切除（93.42%），3例为3级（3.95%），2例为4级（2.63%）。总结了四个解剖三角：SOT三角、VOT三角、JVV三角和TVV三角。所有患者术后卡氏功能状态评分均有改善（p<0.05）。然而，出现了一些并发症，包括声音嘶哑和脑脊液漏。
ABS和SIM分类是选择手术入路和预测FMM手术难度的客观指标，掌握四个“三角”的内容、与肿瘤的位置关系及可变的解剖结构对手术成功至关重要。
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