| Objective: This study aims at investigating a better approach to increase the resection rate of large and giant petroclival meningiomas,reduce complications of surgery,and improve the curative effect.We analyze the combined subtemporal and retrosigmoid keyhole approach for several petroclival meningiomas microsurgeries,and thus provide further reference for surgical treatment of petroclival meningiomas.Methods: The clinical and follow-up data of 24 patients with large and giant petroclival meningiomas treated with combined subtemporal and retrosigmoid keyhole approach in the Army General Hospital between January 2011 and June 2016,was collected and used for retrospective analysis.The data was statistically analyzed by SPSS 18.0 software,with paired-t test and Fisher exact probability for measurement and enumeration data respectively.And then we summarized the surgical trait and experience,studied the clinical therapeutical effect,explored the influencing factors of petroclival meningiomas resection rate,and analyzed the postoperative quality of life of the follow-up patients.Results: In the 24 patients,the tumor sizes are ranged from 35 to 73 mm(mean: 50.4±10.5 mm).The gross total resection of tumor(Simpson Grade?and ?)reaches to 20 cases(83.3%),and the subtotal resection(Simpson Grade?)is achieved in 4 cases(16.7%).New-onset or aggravated original neurological dysfunction after operation appears in 7 cases(29.2%),including 3 cases of ocular motility paralysis(12.5%),4 cases of facial paralysis(16.7%),1 case of hearing impairment(4.2%)and 2 cases of hemiplegia(8.3%).Whereas,the cranial nerves paralysis are partially improved in half a year.Besides,the postoperative complications include brain stem hemorrhage,brain stem infarction,cerebrospinal fluid leakage,intracranial infection in 1 case of each type(4.2%),and pulmonary infection in 2 cases(8.3%),which are all recovered with conservative treatment.There are no complications such as sigmoid sinus embolism and Labbe vein injury.And there is no death during perioperative period.Preoperative and postoperative KPS score are 77.50±8.47 and 72.92±15.17 respectively,and the last follow-up KPS score of all 24 patients is 80.42±14.29.The last follow-up KPS score shows desirable quality of life for 21 patients(87.5%),good quality of life for 1 patient(4.2%)and poor quality of life for 2 patients(8.3%).In the postoperative follow-up period ranged from 3 to 59 months,there is no tumor recurrence or significant residual tumor progress.The results indicate:(1)Tumor resection rate is associated with tumor texture,and whether or not the brain stem or cavernous sinus has been encroached,or neurovascular structure has been wrapped;(2)There was no direct relationship between the gross total resection of tumor and the occurrence of postoperative complications;(3)Postoperative quality of life depends on neurological dysfunctions that may occur after surgery.Conclusion:(1)The combined subtemporal and retrosigmoid keyhole approach is a safe and effective microsurgery for treatment of large and giant petroclival meningiomas extending into middle and posterior cranial fossa and/or supratentorial and infratentorial regions.It provides clear operation field,and improves gross total resection rate with less surgical trauma and complications.(2)When the tumor tightly adheres to brain stem,cavernous sinus,important nerves and vessels of the skull base,it cannot be separated and removed by force so as to avoid serious adverse consequences.The radiotherapy may be a suitable treatment for residual tumors.(3)The postoperative quality of life with petroclival meningiomas does not depend on the gross total resection rate.Therefore,we cannot sacrifice nerve function of the patients to seek the higher gross total resection rate,which may result in adverse consequences and depress postoperative quality of life to patients. |
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