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目的探讨岩斜脑膜瘤的临床特点、手术策略、手术技巧和治疗效果。方法回顾性分析临床资料完整的15例岩斜脑膜瘤病例,总结其临床特点。本组均采用经Kawase入路,手术策略为全切除岩斜区肿瘤,术后辅以γ刀治疗。分析手术后颅神经功能和患者生存状况。结果头痛头晕、外展麻痹和面部麻木是岩斜脑膜瘤的主要症状。手术近全切除肿瘤13例,次全切除2例。12例残余肿瘤术后行γ刀治疗。无手术死亡,术后无新增颅神经损害6例,出现动眼神经麻痹6例,面部麻木7例,外展功能障碍4例,面瘫7例。随访6~59个月(平均38.6个月),12例恢复正常工作和生活,2例生活自理,1例生活需他人照顾。13例无肿瘤复发,2例残余肿瘤增大者中1例经γ刀治疗肿瘤生长得到控制。动眼神经麻痹和面瘫均改善,面部麻木5例部分缓解,外展功能障碍无明显改善。结论对岩斜脑膜瘤应采用合理的手术策略,尽可能减少手术引起的神经损害,有利于提高患者的生存质量。
Objective To investigate the clinical features, surgical strategies, surgical techniques and therapeutic effects of petroclival meningioma. Methods A retrospective analysis of 15 cases of complete clinical data of rock meningioma cases, summarizes its clinical features. This group were used by the Kawase approach, the surgical strategy for the total removal of petroclival tumors, postoperative supplemented by gamma knife treatment. Analysis of postoperative cranial nerve function and patient survival. Headache dizziness, paralysis of the abduction and facial numbness are the main symptoms of petroclival meningiomas. Surgical resection of the tumor nearly 13 cases, subtotal resection in 2 cases. 12 cases of residual tumor were treated with gamma knife. No operative death, no additional cranial nerve damage after surgery in 6 cases, oculomotor nerve paralysis occurred in 6 cases, facial numbness in 7 cases, 4 cases of abduction dysfunction, facial paralysis in 7 cases. All the patients were followed up for 6 to 59 months (average 38.6 months). Twelve patients returned to normal working and living conditions. Two patients took care of themselves and one was required to take care of others. Thirteen patients had no tumor recurrence, and one of the two patients with residual tumor enlargement was controlled by gamma knife treatment of tumor growth. Oculomotor nerve paralysis and facial paralysis were improved, facial numbness in 5 cases partially relieved, abduction dysfunction no significant improvement. Conclusion It is suggested that reasonable surgical strategies should be adopted for petroclival meningioma to minimize the nerve damage caused by surgery and improve the quality of life of patients.