Couldwell W T, Fukushima T, Giannotta S L, Weiss M H
Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles, USA.
J Neurosurg. 1996 Jan;84(1):20-8. doi: 10.3171/jns.1996.84.1.0020.
The surgical removal of petroclival meningiomas has historically been associated with a high incidence of morbidity and mortality. The 109 consecutive patients included in the present retrospective study represent a combined series of tumors operated on by the four authors during a period from 1980 to 1992. The series is composed of 40 men and 69 women ranging in age from 25 to 75 years (mean 51 years). Surgical approaches to tumors in this series included simple retromastoid (60 cases), combined supra- and infratentorial petrosal (22), transtemporal (primary transsigmoid retrolabyrinthine, translabyrinthine, or transcochlear (12), subtemporal (11), and frontotemporal transcavernous (eight). Gross-total removal was achieved in 75 patients (69%). Recurrence or progression of disease occurred in 14 patients (13%) over a 6.1-year mean follow-up period, and it was found within the cavernous sinus in 12 of these cases. Four recurrent cases demonstrated histological compatibility with malignant meningioma. Perioperative death occurred in four patients, and there were 56 significant complications in 35 other patients. Review of this series, with the attendant complications, has facilitated the authors' decision-making when considering the risk of gross-total removal in selected patients with asymptomatic cavernous sinus invasion or tumor adherent to the brainstem.
从历史上看，岩斜区脑膜瘤的手术切除与高发病率和死亡率相关。本回顾性研究纳入的109例连续患者代表了四位作者在1980年至1992年期间手术治疗的一系列肿瘤。该系列包括40名男性和69名女性，年龄在25至75岁之间（平均51岁）。该系列肿瘤的手术入路包括单纯乳突后入路（60例）、幕上和幕下联合岩骨入路（22例）、经颞入路（主要是经乙状窦后迷路后入路、经迷路入路或经耳蜗入路，12例）、颞下入路（11例）和额颞经海绵窦入路（8例）。75例患者（69%）实现了肿瘤全切。在平均6.1年的随访期内，14例患者（13%）出现疾病复发或进展，其中12例发生在海绵窦内。4例复发病例的组织学表现符合恶性脑膜瘤。4例患者围手术期死亡，另外35例患者出现56例严重并发症。对该系列病例及其伴随的并发症进行回顾，有助于作者在考虑对无症状海绵窦侵犯或肿瘤粘连于脑干的特定患者进行肿瘤全切的风险时做出决策。
