岩斜区脑膜瘤的显微外科治疗：24例病例报告

发布时间：2018-04-27 17:09

本文选题：岩斜区 + 脑膜瘤　；参考：《上海交通大学》2015年博士论文

【摘要】：目的:分析总结显微手术治疗岩斜区脑膜瘤的效果,并初步探讨手术入路的选择,肿瘤切除程度的影响因素,患者预后的影响因素,来探索手术治疗岩斜区脑膜瘤的最优方案,提高手术治疗效果和患者术后生活质量。方法:回顾性分析上海交通大学医学院附属仁济医院神经外科从2010年1月到2014年12月显微手术治疗的24例岩斜区脑膜瘤患者的临床资料、影像学资料、手术资料及随访资料。男性10例,女性14例,男女比为1:1.4,平均年龄(49.1±8.9)岁(31-62岁),平均病程(16.3±29.6)个月(0.1-120个月)。患者主要症状包括饮水呛咳、头痛、行走不稳、面部感觉异常、听力下降、肌力下降、肢体感觉异常、面部疼痛、视力下降、复视等。肿瘤平均直径(3.9±1.0)cm(2.3-5.5cm)。手术入路包括枕下乙状窦后入路12例,乙状窦前入路5例,颞下经天幕入路5例,眶颧入路1例,远外侧入路1例。结果:24例患者中,肿瘤完全切除(Simpson II级)10例(41.7%),次全切除(Simpson III级)6例(25%),大部分切除(Simpson IV级)8例(33.3%)。术后并发症包括颅内感染1例(4.2%),肺部感染1例(4.2%),癫痫1例(4.2%),暂时性失语1例(4.2%)。术后新发神经功能障碍包括动眼神经麻痹4例(16.7%),面神经麻痹3例(12.5%),外展神经麻痹2例(8.3%),偏瘫2例(8.3%),三叉神经功能障碍1例(4.2%)。无围手术期死亡病例。24例患者全部得到随访,平均随访时间(31.4±17.5)个月(1-62个月),随访生活质量优秀18例(75.0%),生活质量良好4例(16.7%),生活不能自理2例(8.3%),8例大部分切除患者中有4例行伽马刀治疗,1例行普通放疗,未发现残余肿瘤进展或肿瘤复发病例。患者随访KPS评分与术前KPS评分(t=-2.174,P=0.040)和术后KPS评分(t=-3.301,P=0.003)的差异有统计学意义,肿瘤全切率与肿瘤质地(P=0.022)、海绵窦侵犯(P=0.024)、脑干粘连程度(P=0.005)显著相关,肿瘤质地对随访KPS评分有显著影响(P=0.001)。结论:1.岩斜区脑膜瘤多为良性肿瘤,生长缓慢,且手术难度大,术后并发症多,肿瘤直径小于3cm且无临床症状的患者可行定期影像学随访,一旦发现肿瘤直径超过3cm或患者出现临床症状,应行手术治疗;2.根据肿瘤特点选择合适的手术入路,有利于提高肿瘤的全切率,枕下乙状窦后入路是一种简单、安全、有效的切除岩斜区脑膜瘤的手术入路;3.肿瘤切除程度与肿瘤质地、海绵窦侵犯、脑干粘连程度显著相关;4.岩斜区脑膜瘤患者术后生活质量与肿瘤质地显著相关;5.辅助放射治疗可以有效的控制岩斜区脑膜瘤的生长,降低肿瘤复发进展率;6.充分的术前评估是十分重要的,综合考虑肿瘤特点、患者自身情况、术者经验及手术预期目标等多方面因素,选择正确合理的手术入路,制定个体化的治疗方案,找到最大限度保留患者神经功能和提高肿瘤切除程度之间的平衡点,争取获得肿瘤的完全切除,有利于降低术后并发症率,提高患者术后生活质量。
[Abstract]:Objective: to analyze and summarize the effect of microsurgical treatment of petroclival meningioma, and to explore the choice of surgical approach, the factors influencing the degree of tumor resection and the factors influencing the prognosis of the patients, so as to explore the optimal treatment scheme for the patients with petroclival meningioma. To improve the effect of operation and the quality of life after operation. Methods: the clinical data, imaging data, surgical data and follow-up data of 24 patients with petroclival meningioma treated by microsurgery in Renji Hospital affiliated to Shanghai Jiaotong University from January 2010 to December 2014 were retrospectively analyzed. There were 10 males and 14 females, the ratio of males to females was 1: 1.4, the average age was 49.1 卤8.9 years old and the mean course of disease was 16.3 卤29.6months or 0.1-120 months. The main symptoms include drinking cough, headache, walking instability, abnormal facial sensation, hearing loss, muscle strength decline, limb sensory abnormality, facial pain, visual decline, diplopia and so on. The mean diameter of tumor was 3.9 卤1.0 cm ~ (-1) cm ~ (2. 3) ~ 5.5 cm ~ (-1). The operative approach included retrosigmoid suboccipital approach (12 cases), anterior sigmoid sinus approach (5 cases), infratemporal transatentorial approach (5 cases), orbital zygomatic approach (1 case) and far lateral approach (1 case). Results among the 24 cases, 10 cases were resected completely, 6 cases had subtotal resection of III grade III and 8 cases had 3. 3%. Postoperative complications included intracranial infection in 1 case, pulmonary infection in 1 case, epilepsy in 1 case and transient aphasia in 1 case. Postoperative new nerve dysfunction included oculomotor palsy (n = 4), facial nerve palsy (n = 3), abducens nerve palsy (n = 2), hemiplegia (n = 2) and trigeminal nerve dysfunction (n = 1). All 24 patients with no perioperative death were followed up. The average follow-up time was 31. 4 卤17. 5 months or 1-62 months. The quality of life was excellent in 18 cases. The quality of life was good in 4 cases, and 2 cases were unable to take care of themselves. Of the 8 cases with major resection, 4 cases were treated with gamma knife and 1 case was treated with conventional radiotherapy. No residual tumor progression or recurrence was found. There was a significant difference between the KPS scores of the patients and the preoperative KPS scores (P 0.040) and the postoperative KPS scores (t = -3.301 and P 0.003). The total tumor removal rate was significantly correlated with the quality of the tumor, the cavernous sinus invasion (P < 0.024), and the degree of brain stem adhesion (P 0.005), and the tumor texture had a significant effect on the KPS score (P 0.001). Conclusion 1. The patients with petrosal oblique meningioma are mostly benign tumors, whose growth is slow, the operation is difficult, and there are many postoperative complications. The patients whose tumor diameter is smaller than 3cm and have no clinical symptoms can be followed up regularly. Once the diameter of the tumor exceeds 3cm or the patient has clinical symptoms, surgical treatment should be performed. According to the characteristics of the tumor, choosing a suitable operative approach is helpful to improve the total resection rate of the tumor. The retrosigmoid suboccipital approach is a simple, safe and effective surgical approach for the resection of petroclival meningiomas. The degree of tumor resection was significantly correlated with tumor texture, cavernous sinus invasion and brain stem adhesion. There was a significant correlation between the quality of life and tumor texture in patients with petroclival meningioma. Adjuvant radiotherapy can effectively control the growth of petroclival meningioma and reduce the recurrence and progression rate of tumor. It is very important to evaluate the operation before operation. Taking into account the characteristics of tumor, the patient's own condition, the experience of the operator and the target of the operation, we should choose the correct and reasonable operative approach and make the individualized treatment plan. Finding the balance point between preserving the nerve function of the patients and improving the degree of tumor resection to obtain the complete resection of the tumor is helpful to reduce the rate of postoperative complications and improve the quality of life of the patients after operation.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R739.45

【相似文献】