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The pretemporal trans-cavernous trans-Meckel's trans-tentorial trans-petrosal approach: a combo skill in treating skull base meningiomas.
Journal of Neuro-Oncology ( IF 3.9 ) Pub Date : 2020-02-04 , DOI: 10.1007/s11060-019-03354-1
Shao-Ching Chen,Chun-Fu Lin,Chih-Hsiang Liao,Vicent Quilis-Quesada,Jui-To Wang,Wei-Hsin Wang,Sanford P C Hsu

PURPOSE Surgical treatments for skull base meningiomas are challenging. We found that most of these lesions (75%), despite locating at the anterior, middle or posterior fossa, could be dealt with a combo skill-the pretemporal trans-cavernous trans-Meckel's trans-tentorial trans-petrosal approach (PCMTP), which adopted the same curvilinear skin incision as for the classic pterional approach. Our aim of this study is to validate the application of this technique in treating skull base meningiomas. METHODS Patients underwent surgical intervention at our institute during 2010-2018 were retrospectively reviewed. We statistically analyzed the clinical, radiological, and pathological outcomes. RESULTS In total, 109 patients operated with at least part of the PCMTP combo technique were included. The median follow-up time was 26.6 months. Tumor locations were categorized into: Zone I-sphenoid ridge, olfactory groove, and juxtasellar meningiomas which could be dealt with pterional approach. Zone II-clinoidal and cavernous sinus meningiomas which could be dealt with pretemporal trans-cavernous approach. Zone III-Meckel's and Incisura meningiomas which could be dealt with trans-Meckel's trans tentorial approach. Zone IV-petroclival menigiomas which could be dealt with trans-petrosal approach. When an extensive tumor occupied the anterior, middle, and posterior fossa, the whole combination of the PCMTP technique was applied. The mortality rate is 3.7% (4 patients). Three patients (2.8%) suffered from postoperative deterioration and required occasional assistance. The location of tumor was associated with different Simpson grade removal (p = 0.0015) and resection rate (p < 0.001). CONCLUSION The PCMTP is effective in treating skull base meningiomas.

中文翻译:

颞前海绵体反穿-Meckel的跨腱鞘穿经法:治疗颅底脑膜瘤的一种综合技能。

目的颅底脑膜瘤的外科治疗具有挑战性。我们发现,尽管这些病变位于前,中或后颅窝,但大多数病变(75%)可通过组合技能进行处理-颞前穿海绵体-Meckel穿刺-经颅-经颅-经颅穿刺入路(PCMTP),采用与经典翼状approach入方法相同的曲线皮肤切口。我们这项研究的目的是验证该技术在治疗颅底脑膜瘤中的应用。方法回顾性分析我院2010-2018年接受外科手术治疗的患者。我们对临床,放射学和病理结果进行了统计学分析。结果总共包括109例接受了至少部分PCMTP联合技术手术的患者。中位随访时间为26.6个月。肿瘤部位可分为:I区蝶骨,嗅沟和近侧脑膜瘤,可通过翼状入路处理。II区-海绵状和海绵窦性脑膜瘤可通过颞前跨海绵体入路治疗。III区-Meckel和Incisura脑膜瘤可以用Trans-Meckel的跨膜穿刺法治疗。Ⅳ区-岩斜半月板瘤可通过经岩面入路处理。当广泛的肿瘤占据前,中和后颅窝时,将应用PCMTP技术的整个组合。死亡率为3.7%(4例患者)。三名患者(2.8%)术后恶化,需要偶尔协助。肿瘤的位置与不同的辛普森分级去除率(p = 0.0015)和切除率(p <0)相关。001)。结论PCMTP可有效治疗颅底脑膜瘤。
更新日期:2020-02-04
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