【作者】 周庆九；

【导师】 栾新平；

【作者基本信息】 新疆医科大学 ， 外科学（专业学位）， 2013， 博士

【摘要】 目的：1）探讨颞枕经小脑幕-岩嵴入路切除岩斜区脑膜瘤的手术方法和技巧，以提高手术全切率和改善预后；2）探讨枕下乙状窦后-内听道上入路切除岩斜区脑膜瘤的手术方法和技巧，以提高手术全切率和改善预后；3）探讨神经内镜辅助显微镜切除岩斜区脑膜瘤的手术方法和技巧，以提高手术全切率和改善预后。方法：1）回顾性分析新疆医科大学第一附属医院神经外科2000年1月至2011年6月经颞枕经小脑幕-岩嵴入路显微手术切除32例岩斜区脑膜瘤的临床资料，对该手术的适应症和优缺点进行分析。2）选取新疆医科大学第一附属医院神经外科2000年1月至2007年1月，应用枕下乙状窦后入路切除岩斜区脑膜瘤16例和2007年1月至2011年12月应用枕下乙状窦后-内听道上入路切除岩斜区脑膜瘤18例，对34例岩斜区脑膜瘤的临床资料进行分析，进行两种手术入路的对比研究。3）选取新疆医科大学第一附属医院神经外科2010年1月至2012年1月，使用神经内镜辅助显微镜切除岩斜区脑膜瘤12例，同时选取2005年1月至2010年1月，在临床资料具有可比性的显微镜手术的岩斜区脑膜瘤12例做为对照，对24例岩斜区脑膜瘤的临床资料进行分析，进行两种手术方法的对比研究。结果：1）颞枕经小脑幕-岩嵴入路切除32例岩斜区脑膜瘤，肿瘤全切除12例，次全切除12例，大部分切除8例。全切除术后的近期和远期并发症最高（P＜0.05），而次全切除与大部分切除相比，其术后的近期和远期并发症均无差异（P＞0.05）；2）34例岩斜区脑膜瘤患者，乙状窦后入路组16例，全切除3例，次全切除5例，大部切除8例；内听道上入路组18例，全切除12例，近全切除5例，大部切除1例。内听道上入路组肿瘤的全切除率高于乙状窦后入路组（P＜0.05）。与乙状窦后入路相比，枕下乙状窦后-内听道上入路没有增加术后的近期并发症（P＞0.05），同时可以降低术后的远期并发症（P＜0.05）。3）神经内镜组12例岩斜区脑膜瘤，全切6例，近全切除5例，大部切除1例；显微镜手术组12例岩斜区脑膜瘤，全切2例，近全切除3例，大部切除7例；神经内镜辅助组岩斜区脑膜瘤的全切除和次全切除率高于显微镜手术组（P＜0.05）。神经内镜辅助组术后的近期和远期并发症与显微镜手术组没有差别（P＞0.05）。结论：1）颞枕经小脑幕-岩嵴入路适合于肿瘤的主体在中颅窝，少部分向后颅窝生长的岩斜区脑膜瘤（I型）；选择次全切除肿瘤是一个合理的治疗策略；2）枕下乙状窦后-内听道上入路适合于肿瘤以后颅窝生长为主，少部分向中颅窝生长的岩斜区脑膜瘤（II型）；枕下乙状窦后-内听道上入路与枕下乙状窦后入路相比，可以提高肿瘤的全切率，提高术后患者的生活质量；3）使用神经内镜辅助显微镜手术切除岩斜区脑膜瘤，可以提高肿瘤的全切除和次全切除率；使用神经内镜辅助显微镜手术切除岩斜区脑膜瘤，安全，有效。不会增加手术后的近期和远期并发症。更多还原

【Abstract】 Objective:1) To study the removal technique and operative experience in themicrosurgical resection of petroclival meningiomas by tempoccipital transtentorial andtranspetrosal approach, and improve the rate of total resection of tumors and thepostoperative results.2) To study the removal technique and operative experience in themicrosurgical resection of petroclival meningiomas by trans-suboccipital retrosigmoidsuprameatal approach, and improve the rate of total resection of tumors and thepostoperative results.3) To study the removal technique and operative experience in themicrosurgical resection of petroclival meningiomas assisted with neuroendoscopy, andimprove the rate of total resection of tumors and the postoperative results. Methods:1)The retrospective analysis of thirty two cases of petroclival meningiomas treated fromJan.2000to Jun.2011was performed in the first affiliated hospital, xinjiang medicaluniversity. All the tumors were resected through tempoccipital transtentorial andtranspetrosal approach.2) The retrospective analysis of thirty four cases of petroclivalmeningiomas treated from Jan.2000to Dec.2011was performed in the first affiliatedhospital, xinjiang medical university.Sixteen tumors treated from Jan.2000to Jan.2007were resected through trans-suboccipital retrosigmoid approach, while eighteen tumorstreated from Jan.2007to Dec.2011were resected through trans-suboccipitalretrosigmoid suprameatal approach.3) The retrospective analysis of twenty four cases ofpetroclival meningiomas treated from Jan.2005to Jan.2012was performed in the firstaffiliated hospital, xinjiang medical university.Twelve tumors treated from Jan.2005toJan.2010were resected through microscope, while twelve tumors treated from Jan.2010to Jan.2012were resected through microscope assisted with neuroendoscopy. Results:1)The gross total resection was achieved in twelve cases, near total resection in twelvecases, and subtotal resection in eight cases. The complications of gross total resection ishigher than near total and subtotal resection (P＜0.05).and there were no difference ofthe complications and seguelae between the near total resection and subtotal resection (P＞0.05).2) In the group of tumors resected through trans-suboccipital retrosigmoid approach, there were sixteen cases, the gross total resection was achieved in three cases,near total resection in five cases, and subtotal resection in eight cases. and in the group oftumors resected through trans-suboccipital retrosigmoid suprameatal approach, therewere eighteen cases, the gross total resection was achieved in twelve cases, near totalresection in five cases, and subtotal resection in one cases. The percent of gross totalresection through trans-suboccipital retrosigmoid suprameatal approach was higher thanthat through trans-suboccipital retrosigmoid approach (P＜0.05). There were nodifference in the complications of two group (P＞0.05), while the perent of seguelae inthe group resected through trans-suboccipital retrosigmoid suprameatal approach waslower than the group resected through trans-suboccipital retrosigmoid approach (P＜0.05).3) In the group of tumors resected through microscope, there were twelve cases,the gross total resection was achieved in two cases, near total resection in three cases, andsubtotal resection in seven cases. and in the group of tumors resected through microscopeassisted with neuroendoscopy, there were twelve cases, the gross total resection wasachieved in six cases, near total resection in five cases, and subtotal resection in onecases. The percent of gross and near total resection through microscope assisted withneuroendoscopy was higher than that through microscope (P＜0.05). There were nodifference in the complications and seguelae of two groups (P＞0.05). Conclusion:1)Tempoccipital transtentorial and transpetrosal approach is suitable for petroclivalmeningiomas mainly in middle fossa with extension to posterior fossa (type I) to improvethe rate of gross and near total resection of tumors. For good postoperative results, neartotal resection is a reseanable choise.2) Trans-suboccipital retrosigmoid suprameatalapproach is suitable for petroclival meningiomas mainly in posterior fossa with extensionto middle fossa (type II) to improve the rate of gross and near total resection of tumors.To resect petroclival meningiomas, trans-suboccipital retrosigmoid suprameatal approachis better than trans-suboccipital retrosigmoid suprameatal approach.3) Microsurgicalresection of petroclival meningiomas assisted with neuroendoscopy is better than thatthrough microscope.更多还原