Kawase T, Shiobara R, Toya S
Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan.
Acta Neurochir (Wien). 1994;129(3-4):113-20. doi: 10.1007/BF01406489.
Forty-two patients with petroclival meningioma were operated upon by the middle fossa transpetrosal-transtentorial approaches since 1977. Half of those showed tumour extension into the middle fossa and one-third in the cavernous sinus. Seventeen (40%) had a large tumour of 40 mm in diameter or larger, and 8 of those had a broad attachment from the clivus to petrous pyramid of the temporal bone. The site of pyramid resection was selected from three types, depending on the tumour location and the patients' pre-operative hearing. There was no surgical mortality. Significant risk of lower cranial nerves palsy was minimal and useful hearing was preserved in 18 out of 21 patients. The follow-up, an average of 4 and a half years, showed tumours were completely eradicated in 32 patients (76%) and there was regrowth in 3 (7%). Thirty-four patients (81%) were independent, 3 disabled and only one died of rapid tumour regrowth. The most influential factor on surgical results was the extent to which the tumour had invaded the brain stem. The presence or absence of arterial encasement and of peritumoural oedema on MRI were important in the selection for radical surgery.
自1977年以来，42例岩斜区脑膜瘤患者接受了经中颅窝经颞骨岩部-经小脑幕入路手术。其中一半患者的肿瘤延伸至中颅窝，三分之一延伸至海绵窦。17例（40%）患者的肿瘤直径达40毫米或更大，其中8例肿瘤从斜坡至颞骨岩部有广泛附着。根据肿瘤位置和患者术前听力，从三种类型中选择岩部切除部位。无手术死亡病例。较低颅神经麻痹的显著风险极小，21例患者中有18例保留了有用听力。平均4年半的随访显示，32例患者（76%）的肿瘤被完全切除，3例（7%）复发。34例患者（81%）可独立生活，3例残疾，仅1例因肿瘤快速复发死亡。对手术结果影响最大的因素是肿瘤侵犯脑干的程度。MRI上有无动脉包绕和瘤周水肿对根治性手术的选择很重要。
