经乙状窦后入路治疗岩斜区脑膜瘤策略分析
发布时间：2018-09-12 17:20
【摘要】：目的:通过分析岩斜区脑膜瘤手术治疗后颅神经损伤、KPS评分及肿瘤复发和(或)进展情况定义肿瘤切除目标、分析总结显微手术切除岩斜区以后颅窝为主体的脑膜瘤的治疗效果,减少手术相关术后并发症,减低颅神经损害术后致残率,提升患者术后生存质量。资料和方法:回顾性分析2006.1.-2013.12.经乙状窦后入路手术治疗岩斜区脑膜瘤39例患者的临床资料、影像资料、术后强化核磁影像资料以及术后随访资料。39例岩斜区脑膜瘤患者全部为首次接受手术治疗。男性5例(12.82%),女性34例(87.28%),年龄36-74岁,平均年龄53.79±7.94岁。患者临床症状表现为头痛或头晕、面部麻木或疼痛、面瘫或面肌痉挛、听力下降、肢体无力、走路不稳及吞咽困难。肿瘤直径:小型(10mm)0例,中型(10-24mm)3例,大型(25-44mm)29例,巨大型(≥45mm)7例。应用生活质量评分(Karnofsky Performance Scale KPS评分)评价患者的术后生存状态。仔细收集患者术前的病史、查体、各颅神经的神经功能情况、放射影像学结果,术后详细记录患者的肿瘤性质、各颅神经的神经功能情况及随访时受损颅神经的恢复情况、定期随访时的影像学复发和(或)进展情况以及患者术后生存质量的评分等资料。将岩斜脑膜瘤简化为三个分型:Ⅰ型,肿瘤主体位于小脑幕下;Ⅱ型,肿瘤主体位于小脑幕上;Ⅲ型,幕上下均等性。并根据分型选择手术入路:Ⅰ型采用乙状窦后入路或乙状窦后经小脑幕入路;Ⅱ型采用颞下经小脑幕入路;Ⅲ型应用经岩骨乙状窦前入路或颞下-乙状窦后联合入路。将患者的相关数据资料录入IBM SPSS 17.0统计学软件,并利用可行的统计学方法进行统计学分析。对肿瘤切除的程度、颅神经损伤、肿瘤复发与残留肿瘤进展、患者随访期末各颅神经功能状态和患者随访终末生存质量等方面进行分析总结。结果:39例岩斜区脑膜瘤病例,其中肿瘤达到全切除(GTR)11例(28.21%),肿瘤达到次全切除(STR)28例(71.79%)。全组无重残及死亡病例;术后新增神经功能障碍10例(25.61%),全切除组6例(54.55%),次全切除组4例(14.28%)。术后有效随访36例(92.31%),随访年限平均为41.53月(13月-96月)。随访36例随访病例中,7例(19.44%)仍有不同程度的神经功能障碍,其中永久性致残患者3例(8.33%)。术后全切除组平均KPS评分72.00±9.19分,次全切除组平均KPS评分82.69±10.41分。全切除组无复发,次全切除组进展率11.54%(3/26);次全切除组经伽玛刀治疗(11例)后肿瘤无进展(主动接受伽玛刀治疗8例,被动接受伽玛刀治疗3例)。采用t检验比较和Fisher确切概率法进行统计分析,次全切除组中伽玛刀治疗与肿瘤复发率的关系(Fisher确切概率法P=0.529),两组无明显差别;肿瘤全切除(GTR)组与次全切除(STR)组随访KPS评分(t=-2.844,P=0.007)和KPS评分优秀率(Fisher确切概率法P=0.018),两组间差异均具有统计学意义;术后新增神经功能障碍(Fisher确切概率法P=0.017),两组间差异均具有统计学意义。结论:1.本组岩斜区脑膜瘤分型可指导手术入路的选择;2.枕下乙状窦后及其扩展入路入路是一种操作简单、手术相关并发症少的手术入路;3.对岩斜区脑膜瘤术中残留的部分肿瘤术后行伽玛刀放射治疗可以控制残余肿瘤的进展率4.最大限度保留患者神经功能,有利于提升生存质量,改善预后;5.对岩斜区脑膜瘤行次全切除手术治疗(伴或不伴术后伽玛刀治疗)是一种可行的、经过临床实践的策略。
[Abstract]:Objective: To define the tumor resection target by analyzing cranial nerve injury, KPS score, tumor recurrence and/or progression after surgical treatment of petroclival meningiomas, and to analyze and summarize the therapeutic effect of microsurgical resection of cranial fossa-dominated meningiomas after petroclival meningiomas, so as to reduce postoperative complications and disability rate of cranial nerve injury. Materials and Methods: A retrospective analysis of 39 patients with petroclival meningiomas treated by retrosigmoid approach from January 2006 to December 2013 was carried out. All 39 patients with petroclival meningiomas received surgical treatment for the first time. The clinical symptoms were headache or dizziness, facial numbness or pain, facial paralysis or hemifacial spasm, hearing loss, limb weakness, walking instability and dysphagia. Karnofsky Performance Scale KPS score was used to evaluate the postoperative survival status of the patients. The preoperative medical history, physical examination, neurological function of each cranial nerve, radiographic findings, tumor nature, neurological function of each cranial nerve and the damaged cranial nerve during follow-up were carefully collected. The petroclival meningiomas were simplified into three types: type I, the tumor was mainly located under the tentorium of cerebellum; type II, the tumor was mainly located above the tentorium of cerebellum; type III, the supratentorial and supratentorial homogeneity. Type I was retrosigmoid or retrosigmoid transtentorial approach; type II was subtemporal transtentorial approach; and type III was transpetrosal anterior sigmoid approach or combined subtemporal-retrosigmoid approach. Results: Among 39 patients with petroclival meningiomas, 11 (28.21%) had total resection (GTR) and 28 (71.79%) had subtotal resection (STR). There were no severe disability or death in the whole group, 10 cases (25.61%), 6 cases (54.55%) in total resection group and 4 cases (14.28%) in subtotal resection group. The average KPS score of the total resection group and the subtotal resection group was 72.00 (+ 9.19) and 82.69 (+ 10.41). There was no recurrence in the total resection group, and the progression rate of the subtotal resection group was 11.54% (3/26). There was no progression in the subtotal resection group (8 cases received gamma knife treatment actively and 3 cases received gamma knife treatment passively). (t test and Fisher exact probability method) were used to analyze the relationship between gamma knife therapy and tumor recurrence rate in subtotal resection group (Fisher exact probability method P = 0.529), there was no significant difference between the two groups; KPS score (t = - 2.844, P = 0.007) and excellent rate of KPS score (Fisher exact probability method) were used in follow-up between total resection (GTR) group and subtotal resection (STR) group. P = 0.018), the difference between the two groups was statistically significant; the new neurological dysfunction (Fisher exact probability method P = 0.017), the difference between the two groups was statistically significant. Conclusion: 1. The petroclival meningioma classification can guide the choice of surgical approach; 2. Suboccipital retrosigmoid sinus and its extended approach is a simple operation, surgery-related. Surgical approach with fewer complications; 3. Gamma knife radiotherapy for some residual tumors in petroclival region can control the progress rate of residual tumors. 4. Keeping the neurological function of the patients to the maximum is conducive to improving the quality of life and prognosis; 5. Subtotal resection of petroclival region meningiomas (with or without postoperative gamma) Knife therapy) is a feasible and clinically practicable strategy.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45
[Abstract]:Objective: To define the tumor resection target by analyzing cranial nerve injury, KPS score, tumor recurrence and/or progression after surgical treatment of petroclival meningiomas, and to analyze and summarize the therapeutic effect of microsurgical resection of cranial fossa-dominated meningiomas after petroclival meningiomas, so as to reduce postoperative complications and disability rate of cranial nerve injury. Materials and Methods: A retrospective analysis of 39 patients with petroclival meningiomas treated by retrosigmoid approach from January 2006 to December 2013 was carried out. All 39 patients with petroclival meningiomas received surgical treatment for the first time. The clinical symptoms were headache or dizziness, facial numbness or pain, facial paralysis or hemifacial spasm, hearing loss, limb weakness, walking instability and dysphagia. Karnofsky Performance Scale KPS score was used to evaluate the postoperative survival status of the patients. The preoperative medical history, physical examination, neurological function of each cranial nerve, radiographic findings, tumor nature, neurological function of each cranial nerve and the damaged cranial nerve during follow-up were carefully collected. The petroclival meningiomas were simplified into three types: type I, the tumor was mainly located under the tentorium of cerebellum; type II, the tumor was mainly located above the tentorium of cerebellum; type III, the supratentorial and supratentorial homogeneity. Type I was retrosigmoid or retrosigmoid transtentorial approach; type II was subtemporal transtentorial approach; and type III was transpetrosal anterior sigmoid approach or combined subtemporal-retrosigmoid approach. Results: Among 39 patients with petroclival meningiomas, 11 (28.21%) had total resection (GTR) and 28 (71.79%) had subtotal resection (STR). There were no severe disability or death in the whole group, 10 cases (25.61%), 6 cases (54.55%) in total resection group and 4 cases (14.28%) in subtotal resection group. The average KPS score of the total resection group and the subtotal resection group was 72.00 (+ 9.19) and 82.69 (+ 10.41). There was no recurrence in the total resection group, and the progression rate of the subtotal resection group was 11.54% (3/26). There was no progression in the subtotal resection group (8 cases received gamma knife treatment actively and 3 cases received gamma knife treatment passively). (t test and Fisher exact probability method) were used to analyze the relationship between gamma knife therapy and tumor recurrence rate in subtotal resection group (Fisher exact probability method P = 0.529), there was no significant difference between the two groups; KPS score (t = - 2.844, P = 0.007) and excellent rate of KPS score (Fisher exact probability method) were used in follow-up between total resection (GTR) group and subtotal resection (STR) group. P = 0.018), the difference between the two groups was statistically significant; the new neurological dysfunction (Fisher exact probability method P = 0.017), the difference between the two groups was statistically significant. Conclusion: 1. The petroclival meningioma classification can guide the choice of surgical approach; 2. Suboccipital retrosigmoid sinus and its extended approach is a simple operation, surgery-related. Surgical approach with fewer complications; 3. Gamma knife radiotherapy for some residual tumors in petroclival region can control the progress rate of residual tumors. 4. Keeping the neurological function of the patients to the maximum is conducive to improving the quality of life and prognosis; 5. Subtotal resection of petroclival region meningiomas (with or without postoperative gamma) Knife therapy) is a feasible and clinically practicable strategy.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45
【参考文献】
相关期刊论文 前10条
1 陈立华;杨艺;徐如祥;;岩斜区脑膜瘤的手术入路选择及其手术相关问题探讨[J];中华神经医学杂志;2015年03期
2 赵子进;袁贤瑞;邹华元;姜维喜;罗端午;彭泽峰;李学军;廖艺玮;刘庆;;显微手术切除岩斜区脑膜瘤的疗效分析[J];中华神经外科杂志;2015年02期
3 陈立华;徐如祥;;岩斜区脑膜瘤手术入路选择[J];临床神经外科杂志;2014年01期
4 幸标;顾培元;魏栋;陈功;张寒;李猛;胡卫星;;岩斜区肿瘤的风险评估、临床分型与手术入路的选择[J];江苏医药;2013年10期
5 张建;张良;林涛;;岩斜坡区脑膜瘤的显微手术治疗[J];中华神经医学杂志;2012年10期
6 吴震;李达;郝淑煜;王亮;林久銮;汤R，
本文编号：2239701
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2239701.html
最近更新
教材专著
