Clinical Analysis Of 43 Cases Of Petroclival Meningioma Treated By Microsurgery

Objective: Analysis and summary of microsurgical treatment of petroclival meningioma curative effect,and preliminary analysis to explore the degree of tumor resection and prognosis of patients,total tumor resection and non-total resection complications,the incidence of new neurological dysfunction,Patient's prognosis and so on.To seek personalized microsurgical treatment program to improve the cure rate of petroclival meningiomas and reduce the incidence of postoperative neurological dysfunction,postoperative complications and mortality,improve postoperative and long-term quality of life of patients.Material and Method : From September 2015 to December 2017,43 patients with petroclival meningioma undergoing neurosurgical microsurgery in the First Affiliated Hospital of China Medical University were retrospectively analyzed.The imaging data,surgical data And follow-up information.There were 8 males(18.60%)and 35 females(81.40%),aged 39-71 years with an average of 54.26 ± 7.86.Patients duration 0.5-114 months,an average of 23.88 ± 30.31 months.Among them,37 cases were found and accepted surgical treatment for the first time,4 cases were recurred after operation,and 2 cases of tumor progression were found and accepted after radiotherapy for the first time.Tumor size 1.8-4.9cm,average size 3.22 ± 0.97 cm.Preoperative clinical manifestations of patients mainly include headache,facial numbness,blurred vision,tinnitus,trigeminal neuralgia,walking instability,oculomotor nerve paralysis,drinking cough,etc.,of which 2 were found in physical examination.Surgical approach included retrosigmoid approach in 15 cases,presigmoid approach in 22 cases,far-lateral approach in 2 case,presigmoid approach+far-lateral approach in 1 case,Kawase in 3case.The Karnofsky Performance Scale Quality of Life Scale(KPS)was used to assess the quality of life before,during and after follow-up.Patients preoperative KPS score 50-100 points,an average of 76.28 ± 11.34 points.Application of IBM SPSS 24.0 statistical software for the establishment of patient data database,and the application of statistical methods for statistical analysis.The main analysis of total tumor resection and non-total resection complications,the incidence of new neurological dysfunction,hospital stay differences.The factors affecting the degree of tumor resection and the factors influencing the quality of life at follow-up.Results: Of the 43 patients,30 were completely resected and 13 were not completely resected.Patients postoperative hospital stay 10-66 days,an average of 25.81 ± 11.17 days.Postoperative complications of intracranial hematoma,intracranial infection,aphasia,lung infection,cerebral infarction,limb muscle strength decreased,subcutaneous fluid.34 cases of neurological dysfunction were added after operation,KPS score was 10-100 points(average 64.84 ± 23.43 points)after operation,and 6 cases received adjuvant radiotherapy and so on.All 43 patients were followed up for 1-25 months after operation,with an average follow-up time of 11.81 ± 7.10 months.Follow-up cases,3 cases of death,40 cases of survival,of which 18 still have varying degrees of neurological dysfunction.The last follow-up KPS score 0-100 points,an average of 78.84 ± 25.84 points.Using chi-square test or t-test statistics,the difference between the KPS score(P = 0.012)and the total resection group and the non-total resection group was statistically significant.Total tumor resection than non-total resection KPS score high,patients with high quality of life.The average postoperative hospital stay(P = 0.670),complication rate(P = 0.786),postoperative neurological deficit(P = 0.731)and postoperative KPS score(P = 0.358)were not statistically different significance.Using chi-square test and Fisher's exact test,the degree of tumor resection was related to tumor texture(P = 0.0006),blood supply(P = 0.020),invasion of cavernous sinus(P = 0.000),Whether surrounding the nerve and blood vessels(P = 0.000)and other factors.And age,gender,preoperative quality of life,tumor size,degree of brainstem extrusion and other factors are not related.Also using the chi-square test analysis,we obtained the follow-up KPS score and preoperative KPS score(P = 0.047),tumor texture(P = 0015),invasion of cavernous sinus or not(P = 0.038),Whether surrounding the neurovascular(P = 0.032),tumor resection(P = 0.012)or not;There was no significant difference with age,gender,tumor size,extent of brainstem compression and so on.Conlusions: 1.Because petroclival meningiomas frequently invade multiple areas or even multiple cranial skull base,the choice of surgical approach is based primarily on the basal area of invasion of the cranial base of the PCM.2.Total tumor resection patients than non-total removal of patients with high quality of life;petroclival meningioma resection degree and tumor texture,blood flow, whether violations of cavernous sinus,whether the surrounding blood vessels and nerves and other factors.3.Patient follow-up KPS score and preoperative KPS score,tumor texture,degree of resection,whether violations of cavernous sinus and surrounding blood vessels and other factors.4.Improve the preoperative assessment,a clear impact on the degree of tumor resection and prognosis of patients with relevant factors,so as to select the appropriate surgical approach,and then retain the maximum safety of patients under the premise of neurological resection,is conducive to reducing postoperative complications and new Increase the incidence of neurological dysfunction,improve patient quality of life.5.Multimodal neural navigation,electrophysiological detection,endoscopic assisted microscopy in the surgical treatment of rock meningioma in the process of nerve and blood vessel protection is of great significance.6.Stereotactic radiotherapy(gamma knife treatment)for the control of residual tumor progression is safe and effective.