Study And Discussion On The Clinical Effect Of Microsurgery For Petroclival Meningiomas

ObjectivePetroclinic meningiomas is one of the most challenging clinical diseases today.Exploring and analyzing the best surgical approach and surgical curative effect of meningiomas in petroclinic area,so as to reduce postoperative complications,decrease recurrence rate,and provide a theoretical and clinical basis for improving the quality of life after surgical patients.MethodsThe data of this study was retrospectively analyzed,selecting 97 patients with petroclinic meningiomas.The subjects were treated in neurosurgery at the First Affiliated Hospital of Zhengzhou University(time node:August 2012 to June 2019),Of these patients,77 were females,20 males.The age range is between 26 and 74,and the average age was(52.5±10.0)years.According to the location of the main body of the tumor,the size,texture of the tumor,the relationship with the vascular nerve,and the familiarity of the individual surgical approach,the surgical approaches of this study were divided into the following four types:9 cases were presigmoid approach,36 cases were subtemporal transtentorial approach,35 cases were retrosigmoid approach and 17 cases were Kawase approach.Postoperative follow-up was 6～84 months,and the main content contained comparing the total resection degree,postoperative complications,preoperative and postoperative patients KPS scores and tumor recurrence rate of the four groups.Results1.The degree of total tumor resection.The total resection rate of the Kawase approach group(71.5±7.1%)was significantly higher than that of subtemporal transtentorial approach(52.7±8.7%),retrosigmoid approach group(51.5±6.8%)and the presigmoid approach group(54.7±4.8%,P=0.011).While,comparing with subtemporal transtentorial approach,retrosigmoid approach and presigmoid approach group,the difference was not significant(P=0.055).2.Postoperative complications:The complication rate of the Kawase approach group(35.29%)was significantly lower than that subtemporal transtentorial approach(47.22%),retrosigmoid approach group(48.57%)and the presigmoid approach group(66.67%,P=0.003);But the comparison between the subtemporal transtentorial approach(47.22%),the retrosigmoid approach group(48.57%)and the presigmoid approach group(66.67%,P=0.065)was not statistically significant.3.Quality of life score,Postoperative quality of life score of 4 groups were higher than that before operation,Comparison between four groups of preoperative KPS scores,the difference was not significant(P=0.984).The postoperative follow-up was maintained for 6 months,and the results of the postoperative quality of life score:the Kawase approach group(89.1±6.3)was higher than that the presigmoid approach group(83.6±7.2),the subtemporal transtentorial approach group(85.2±4.7)and the retrosigmoid approach group(82.6±8.1)(P=0.041).However,there is no statistically significant comparison among the three groups of the presigmoid sinus approach group,the subtemporal transtentorial approach group and the suboccipital retrosigmoid sinus approach group(P=0.475).4.Postoperative re-examination of tumor recurrence results:Postoperative radiotherapy was given to patients in each group who could not be completely resected,and the follow-up was 4 years without death.the presigmoid approach group tumor recurrence in 1 case(11.1%),the subtemporal transtentorial approach group in 4 cases(11.1%),the retrosigmoid approach group in 5 cases(14.2%),the Kawase approach group in 1 cases(5.8%),overall recurrence rate was 11.3%(11/97).ConclusionFor patients with petroclinic meningiomas,there are many surgical approaches to choose from,and each approach has its own scope of application and advantages and disadvantages.The operation of presigmoid approach has the most postoperative complications,a higher total surgical resection rate,a higher postoperative quality of life and a higher degree of tumor recurrence.The subtemporal transtentorial approach has a lower total resection rate,higher postoperative complications,higher postoperative quality of life,and higher tumor recurrence.The retrosigmoid approach group has the lowest total resection rate,higher postoperative complications,lowest postoperative quality of life,and highest tumor recurrence.Kawase approach has the highest total resection rate,the least postoperative complications,the highest postoperative quality of life,and the lowest degree of tumor recurrence.Compared with the four approaches,the Kawase approach is more suitable for petroclinic meningiomas.According to the location,size,growth direction and personal experience of the tumor,the surgical approach of petroclinic meningioma should follow the principle of individualized treatment and the pursuit of intraoperative tumor resection and serious postoperative complications should be balanced.Patients undergoing stereotactic radiotherapy after surgery.