To Study The Minimally Invasive Microsurgery Of Petroclival Meningiomas

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.