摘要：

目的 探讨经乙状窦后入路治疗岩斜区脑膜瘤的理想切除目标以提高患者术后生活质量。 方法 回顾分析39 例经乙状窦后入路行肿瘤全切除术或次全切除术的岩斜区脑膜瘤患者的临床资料。 结果 肿瘤全切除者11 例（28.21％）、次全切除者28 例（71.79％）。全切除组患者新增脑神经损伤或原有脑神经损伤症状加重的发生率高于次全切除组［6 例（6/11）对4 例（14.29%），Fisher 确切概率法：P = 0.017］，术后KPS 评分低于次全切除组［（72.00 ± 9.19）分对（82.69 ± 10.41）分；t = - 2.844，P =0.007］；而两组肿瘤复发和（或）进展发生率差异无统计学意义（Fisher 确切概率法：P = 0.545）。次全切除组接受与不接受伽马刀治疗，肿瘤复发和（或）进展发生率差异无统计学意义（Fisher 确切概率法：P =0.529）。 结论 岩斜区脑膜瘤经乙状窦后入路行次全切除术，术后辅助或不辅助伽马刀治疗均为可行治疗策略。

关键词: 脑膜瘤, 颅底肿瘤, 显微外科手术

Abstract:

Objective To explore optimal resection goals of petroclival meningiomas resected via retrosigmoid approach for improving quality life of patients after operation. Methods  A total of 39 cases with petroclival meningiomas who underwent microsurgical removal via retrosigmoid approach from January 2006 to December 2013 in our hospital were retrospectively analyzed.  Results  Gross total resection was performed in 11 patients (28.21% ), and subtotal resection was performed in 28 patients (71.79% ). The occurrence rate of new cranial nerve injury or aggravated original cranial nerve injury in gross total resection group was significantly higher than that in subtotal resection group [6 patients (6/11) vs 4 patients (14.29%), Fisher exact probability: P = 0.017]. Postoperative Karnofsky Performance Status (KPS) score in gross total resection group was significantly lower than that in subtotal resection group [(72.00 ± 9.19) score vs (82.69 ± 10.41) score; t = -2.844, P = 0.007]. There was no significant difference between 2 groups on the recurrence and/or progression rate after operation (Fisher exact probability: P = 0.545). There was no significant difference of the recurrence and/or progression rate between with or without gamma knife radiosurgery (GKRS) after operation in subtotal resection group (Fisher exact probability: P = 0.529).  Conclusions  Subtotal resection via retrosigmoid approach with or without gamma knife radiosurgery is reasonable and feasible strategy in the treatment of petroclival meningiomas.

Key words: Meningioma, Skull base neoplasms, Microsurgery