經(jīng)乙狀竇后入路治療巖斜區(qū)腦膜瘤策略分析
發(fā)布時間：2018-09-12 17:20
【摘要】：目的:通過分析巖斜區(qū)腦膜瘤手術(shù)治療后顱神經(jīng)損傷、KPS評分及腫瘤復(fù)發(fā)和(或)進(jìn)展情況定義腫瘤切除目標(biāo)、分析總結(jié)顯微手術(shù)切除巖斜區(qū)以后顱窩為主體的腦膜瘤的治療效果,減少手術(shù)相關(guān)術(shù)后并發(fā)癥,減低顱神經(jīng)損害術(shù)后致殘率,提升患者術(shù)后生存質(zhì)量。資料和方法:回顧性分析2006.1.-2013.12.經(jīng)乙狀竇后入路手術(shù)治療巖斜區(qū)腦膜瘤39例患者的臨床資料、影像資料、術(shù)后強(qiáng)化核磁影像資料以及術(shù)后隨訪資料。39例巖斜區(qū)腦膜瘤患者全部為首次接受手術(shù)治療。男性5例(12.82%),女性34例(87.28%),年齡36-74歲,平均年齡53.79±7.94歲�；颊吲R床癥狀表現(xiàn)為頭痛或頭暈、面部麻木或疼痛、面癱或面肌痙攣、聽力下降、肢體無力、走路不穩(wěn)及吞咽困難。腫瘤直徑:小型(10mm)0例,中型(10-24mm)3例,大型(25-44mm)29例,巨大型(≥45mm)7例。應(yīng)用生活質(zhì)量評分(Karnofsky Performance Scale KPS評分)評價患者的術(shù)后生存狀態(tài)。仔細(xì)收集患者術(shù)前的病史、查體、各顱神經(jīng)的神經(jīng)功能情況、放射影像學(xué)結(jié)果,術(shù)后詳細(xì)記錄患者的腫瘤性質(zhì)、各顱神經(jīng)的神經(jīng)功能情況及隨訪時受損顱神經(jīng)的恢復(fù)情況、定期隨訪時的影像學(xué)復(fù)發(fā)和(或)進(jìn)展情況以及患者術(shù)后生存質(zhì)量的評分等資料。將巖斜腦膜瘤簡化為三個分型:Ⅰ型,腫瘤主體位于小腦幕下;Ⅱ型,腫瘤主體位于小腦幕上;Ⅲ型,幕上下均等性。并根據(jù)分型選擇手術(shù)入路:Ⅰ型采用乙狀竇后入路或乙狀竇后經(jīng)小腦幕入路;Ⅱ型采用顳下經(jīng)小腦幕入路;Ⅲ型應(yīng)用經(jīng)巖骨乙狀竇前入路或顳下-乙狀竇后聯(lián)合入路。將患者的相關(guān)數(shù)據(jù)資料錄入IBM SPSS 17.0統(tǒng)計學(xué)軟件,并利用可行的統(tǒng)計學(xué)方法進(jìn)行統(tǒng)計學(xué)分析。對腫瘤切除的程度、顱神經(jīng)損傷、腫瘤復(fù)發(fā)與殘留腫瘤進(jìn)展、患者隨訪期末各顱神經(jīng)功能狀態(tài)和患者隨訪終末生存質(zhì)量等方面進(jìn)行分析總結(jié)。結(jié)果:39例巖斜區(qū)腦膜瘤病例,其中腫瘤達(dá)到全切除(GTR)11例(28.21%),腫瘤達(dá)到次全切除(STR)28例(71.79%)。全組無重殘及死亡病例;術(shù)后新增神經(jīng)功能障礙10例(25.61%),全切除組6例(54.55%),次全切除組4例(14.28%)。術(shù)后有效隨訪36例(92.31%),隨訪年限平均為41.53月(13月-96月)。隨訪36例隨訪病例中,7例(19.44%)仍有不同程度的神經(jīng)功能障礙,其中永久性致殘患者3例(8.33%)。術(shù)后全切除組平均KPS評分72.00±9.19分,次全切除組平均KPS評分82.69±10.41分。全切除組無復(fù)發(fā),次全切除組進(jìn)展率11.54%(3/26);次全切除組經(jīng)伽瑪?shù)吨委?11例)后腫瘤無進(jìn)展(主動接受伽瑪?shù)吨委?例,被動接受伽瑪?shù)吨委?例)。采用t檢驗(yàn)比較和Fisher確切概率法進(jìn)行統(tǒng)計分析,次全切除組中伽瑪?shù)吨委熍c腫瘤復(fù)發(fā)率的關(guān)系(Fisher確切概率法P=0.529),兩組無明顯差別;腫瘤全切除(GTR)組與次全切除(STR)組隨訪KPS評分(t=-2.844,P=0.007)和KPS評分優(yōu)秀率(Fisher確切概率法P=0.018),兩組間差異均具有統(tǒng)計學(xué)意義;術(shù)后新增神經(jīng)功能障礙(Fisher確切概率法P=0.017),兩組間差異均具有統(tǒng)計學(xué)意義。結(jié)論:1.本組巖斜區(qū)腦膜瘤分型可指導(dǎo)手術(shù)入路的選擇;2.枕下乙狀竇后及其擴(kuò)展入路入路是一種操作簡單、手術(shù)相關(guān)并發(fā)癥少的手術(shù)入路;3.對巖斜區(qū)腦膜瘤術(shù)中殘留的部分腫瘤術(shù)后行伽瑪?shù)斗派渲委熆梢钥刂茪堄嗄[瘤的進(jìn)展率4.最大限度保留患者神經(jīng)功能,有利于提升生存質(zhì)量,改善預(yù)后;5.對巖斜區(qū)腦膜瘤行次全切除手術(shù)治療(伴或不伴術(shù)后伽瑪?shù)吨委?是一種可行的、經(jīng)過臨床實(shí)踐的策略。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.45
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 陳立華;楊藝;徐如祥;;巖斜區(qū)腦膜瘤的手術(shù)入路選擇及其手術(shù)相關(guān)問題探討[J];中華神經(jīng)醫(yī)學(xué)雜志;2015年03期
2 趙子進(jìn);袁賢瑞;鄒華元;姜維喜;羅端午;彭澤峰;李學(xué)軍;廖藝瑋;劉慶;;顯微手術(shù)切除巖斜區(qū)腦膜瘤的療效分析[J];中華神經(jīng)外科雜志;2015年02期
3 陳立華;徐如祥;;巖斜區(qū)腦膜瘤手術(shù)入路選擇[J];臨床神經(jīng)外科雜志;2014年01期
4 幸標(biāo);顧培元;魏棟;陳功;張寒;李猛;胡衛(wèi)星;;巖斜區(qū)腫瘤的風(fēng)險評估、臨床分型與手術(shù)入路的選擇[J];江蘇醫(yī)藥;2013年10期
5 張建;張良;林濤;;巖斜坡區(qū)腦膜瘤的顯微手術(shù)治療[J];中華神經(jīng)醫(yī)學(xué)雜志;2012年10期
6 吳震;李達(dá);郝淑煜;王亮;林久鑾;湯R，
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