Do Hong-Hai, Nguyen Dao Luan Trung, Nguyen Minh-Anh, Nguyen Thanh-Lam
Department of Neurosurgery, University Medical Center, Ho Chi Minh City, Viet Nam.
Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam.
Heliyon. 2025 Feb 19;11(4):e42860. doi: 10.1016/j.heliyon.2025.e42860. eCollection 2025 Feb 28.
Evaluate the surgical results of cerebellopontine angle (CPA) meningiomas via a retrosigmoid approach.
This study investigated the outcomes of the retrosigmoid approach for CPA meningiomas in 36 patients. Demographic characteristics and surgical outcomes were recorded on admission, post-operation for 3-month, and 12-month follow-up. Surgical outcome was measured by using the Glasgow Outcome Scale (GOS), the extent of resection (EOR), and cranial nerve functions. Statistical analysis was conducted to identify the factors influencing outcomes.
The data showed 69.4 % of the patients had a tumor with a size over 30 mm. Intraoperatively, the most common site of dural attachment was supra-meatal (33.3 %) and only one patient had a tumor centered on internal acoustic meatus (IAM). Gross total resection was achieved in 25 patients (69.4 %). Good functional status (GOS 4-5) at discharge was 77.8 % and at 12-month follow-up was 88.9 %. Large tumors (>30 mm) with brainstem compression, brainstem edema, flow-void within tumor, and invasion of cranial foramina (Meckel's cave, jugular foramen) significantly impacted the outcome (p < 0.05). Tumors invading the IAM were associated with a significantly higher risk of facial palsy compared to those without IAM involvement. Besides, aspiration pneumonia was strongly related to poor outcomes (p < 0.05).
Most CPA meningiomas can safely be resected via a retrosigmoid approach, highlighting the importance of meticulous surgical technique and post-operative care. However, careful consideration of factors like tumor size, flow-void within tumor, brainstem compression, brainstem edema, and potential complications (due to invasion of cranial foramina) can help optimize surgical strategy and improve long-term functional outcomes.
通过乙状窦后入路评估桥小脑角（CPA）脑膜瘤的手术效果。
本研究调查了36例采用乙状窦后入路治疗CPA脑膜瘤的患者的治疗结果。记录患者入院时、术后3个月和12个月随访时的人口统计学特征和手术结果。采用格拉斯哥预后量表（GOS）、切除程度（EOR）和颅神经功能来衡量手术结果。进行统计分析以确定影响结果的因素。
数据显示69.4%的患者肿瘤大小超过30mm。术中，硬脑膜附着最常见的部位是颞骨岩部上表面（33.3%），只有1例患者的肿瘤以内耳门（IAM）为中心。25例患者（69.4%）实现了肿瘤全切。出院时功能状态良好（GOS 4 - 5）的患者占77.8%，12个月随访时为88.9%。伴有脑干受压、脑干水肿、肿瘤内血流空洞以及侵犯颅底孔（Meckel腔、颈静脉孔）的大肿瘤（>30mm）对手术结果有显著影响（p < 0.05）。与未累及IAM的肿瘤相比，侵犯IAM的肿瘤发生面瘫的风险显著更高。此外，吸入性肺炎与不良预后密切相关（p < 0.05）。
大多数CPA脑膜瘤可通过乙状窦后入路安全切除，这凸显了精细手术技术和术后护理的重要性。然而，仔细考虑肿瘤大小、肿瘤内血流空洞、脑干受压、脑干水肿以及潜在并发症（由于侵犯颅底孔）等因素有助于优化手术策略并改善长期功能结果。
