Dynamic Retraction Microneurosurgery For The Treatment Of Medial Tentorial Meningiomas

Objective:To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas.Methods : From January 2011 to December 2016,a cohort of 28 patients harboring medial tentorial meingiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University.All patients treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group,and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group.The surgical approaches tailored in our patients were based on predominant direction of tumor extension.The extent of tumor resection was scored according to the Simpson's classification scale.Comparisons of tumor size,operation time,hospitalization time,retraction-related injury,tumor Simpson resection grade and Karnofsky Performance Scale(KPS)score six months after surgery were also made between two groups.Results:A total of 12 patients(retractor group)were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group).The difference between two groups with regard to sex,age,tumor size,operation time and tumor Simpson resection grade was not statistically significant(all P>0.05).The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3±1.8 d vs.20.2±1.3 d,P=0.004).The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group [6.2 %(1/16)vs.50%(6/12),P=0.022].The dynamic retraction group had better neurological recovery rate with KPS > 80 evaluated six months after surgery compared with the retractor group [87.5%(14/16)vs.41.7%(5/12),P=0.017].Conclusions:Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible,which can obviate or reduce the amount of brain retraction needed,and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.