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目的 探讨巨大型岩斜脑膜瘤的手术策略。 方法 回顾性分析 32例直径超过 4 5cm的岩斜脑膜瘤患者手术及预后情况。将患者分为枕下乳突后入路组与颅底外科乙状窦前入路组 ,对其手术时间、肿瘤切除情况、及术后神经功能损伤情况进行对比研究。 结果 枕下乳突后入路组肿瘤全切除率及次全切除率分别为 43%、36 % ;乙状窦前入路组分别为 39%、2 2 % ,两组差异无显著性意义 (P >0 0 5 ) ,但枕下乳突后入路组患者神经功能后遗症的发生率较乙状窦前入路组低且症状轻 ,Karnofsky预后评分较高 [枕下乳突后入路组为 (75± 18)分 ,乙状窦前入路组为 (4 9± 2 6 )分 ],两组差异有显著性意义 (P <0 0 1)。 结论 巨大型岩斜脑膜瘤患者的肿瘤切除情况与手术入路的选择无明显相关性。枕下乳突后入路手术 ,在不加重神经功能损伤的前提下 ,应尽量争取肿瘤全切除 ;如不能全切除 ,应缩小瘤体≤ 3cm ,以利术后放射外科治疗 ,可能是较为安全有效的治疗方案。
Objective To investigate the surgical strategy of giant petroclival meningiomas. Methods Retrospectively analyzed the operation and prognosis of 32 patients with petrous meningioma more than 45cm in diameter. The patients were divided into posterior mastoid posterior approach and posterior sigmoid sinus approach, and their operation time, tumor resection and postoperative neurological damage were compared. Results The total resection rate and subtotal resection rate of suboccipital mastoid approach group were 43% and 36%, respectively. The anterior approach group was 39% and 22% respectively, with no significant difference between the two groups P> 0.05). However, the incidence of neurological sequelae in the suboccipital posterior approach group was lower than that in the sigmoid anterior approach group and was mild with a higher Karnofsky prognosis score (75 ± 18) points and sigmoid sinus approach group (49 ± 2 6 points), the difference between the two groups was significant (P <0.01). Conclusion There is no significant correlation between tumor resection and the choice of surgical approach in huge petrosal meningiomas. Suboccipital mastoid posterior approach surgery, without aggravating neurological damage under the premise of full resection of tumor should be strived; if not total resection, the tumor should be reduced ≤ 3cm, postoperative radiosurgery treatment may be more secure Effective treatment options.