Efficacy Analysis And Clinical Experience Of Two Modified Subtemporal Approach In The Treatment Of Petroclival Meningioma

Objective: To investigate the treatment effects of two different surgical approach for resection of petroclival meningioma.Summarize the surgical techniques in order to improve the total resection rate and reduce postoperative complications.Methods: A retrospective comparative analysis of 20 cases of petroclival meningioma patients by two different surgical approaches in the Second Affiliated Hospital of Dalian Medical University from January 2008 to December 2015 was carried out.The 20 patients were grouped according to the different surgical approaches.Of which,12 cases form the subtemporal transtentorial group,8 cases consist of the Kawase modified subdural group.Results: 1.The resection extent of the tumor: Of the subtemporal transtentorial approach group,7 cases(58.3%)were of the total resection,4 cases(33.3%)were of the subtotal resection,and 1 case(8.3%)was of the partial resection.Of the Kawase approach group,6 cases(75.0%)were of the total resection,2 cases(25.0%)were of the subtotal resection,and 0 cases was of the partial resection.The surgical approach of the two groups has no significant difference(P > 0.05)in tumor resection extent.2.Postoperative complications: In this study,of the subtemporal transtentorial approach group,1 cases(8.3%)occurred the cerebrospinal fluid leakage,2 cases(16.7%)suffered intracranial infection.And of the Kawase approach group,0 cases occurred the cerebrospinal fluid leakage,1 cases(12.5%)suffered intracranial infection,the difference between the two groups was not significant(P > 0.05).Subcutaneous effusion occurred in the subtemporal transtentorial approach group was 4 cases(33.3%),however,in the Kawase approach group was 0 cases,two groups of surgical approach had significant difference(P < 0.05),the incidence of subcutaneous effusion was significantly higher in the postoperative of the subtemporal transtentorial approach group than Kawase approach group.3.Evaluation of neurological function and quality of life:ality of life score: 20 patients,subtemporal transtentorial approach group postoperative occurrence nerve dysfunction in 5 cases(41.6%),improved subdural Kawase approach group 0 cases occurred postoperative neurological dysfunction,the operation of the two groups into the road compared with statistical difference(P < 0.05)and temporal the tentorial approach group postoperative neurological dysfunction incidence was significantly higher than that of the modified epidural under Kawase approach group.Postoperative patients quality of life scores divided into(76.2 + 21.6).Operations in the two groups into the road in contrast with no significant difference(P > 0.05).4.The extent of tumor resection and recurrence of the tumor,13 cases of total resection of tumor recurrence in 2 cases(15.3%),6 cases tumor subtotal underwent radiotherapy recurrence in 2 cases(33.3%),1 case of partial resection underwent radiation therapy without recurrence,extent of resection of the tumor in the tumor recurrence compared with traditional difference(P > 0.05).Conclusion: 1.According to the petroclival meningioma choosing appropriate surgical approach is the key to improve the success rate of surgery and treatment effect.2.Improvement of subdural Kawase approach craniotomy operation has the advantages of simple operation,,small trauma,short time consuming,exposure to a wide range,on the upper slopes and the lateral wall of the cavernous sinus has a good exposure effect.3.The temporal through transtentorial approach with operation area fully exposed,operating room,surgical path short advantages,and is especially suitable for to cross after cranial fossa tumor growth,but the drawback is that the craniotomy is time-consuming and easy to damage the vein of Labbe,operative trauma,postoperative complications of disadvantages.4.The choice of the petroclival meningioma surgery treatment need to weigh the rate of total resection of tumor,quality and tumor recurrence.