Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach
Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach
复制标题
通过背外侧入路手术治疗腹大孔脑膜瘤期间保留下颅神经功能的技术细微差别
DOI：
10.1016/j.wneu.2020.11.140
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发表时间：
2020
影响因子：
2
通讯作者：
YE CHENG
中科院分区：
文献类型：
--
作者：
YE CHENG
本研究建立了经背侧入路切除枕大孔腹侧脑膜瘤(VFMMs)的新技术。选择两个安全区作为手术走廊的入口。安全区I位于第一牙韧带硬膜附着点与颈静脉分支之间，安全区II位于第一牙韧带硬脑膜附着点与颈静脉孔之间。肿瘤首先通过安全区I，然后通过安全区II，通过从尾部到头部的轨迹切除肿瘤，使肿瘤从下方和向下输送，远离脑干和下颅神经。结果33例患者行大体全切除，4例行次全切除。4名患者暂时需要鼻胃喂养管。所有患者均于术后3个月内恢复。3例患者(8.1%)因术后脑神经IX和X受损而出现永久性轻度声音嘶哑和吞咽困难。1例患者行气管切开术。结论在vFMM手术中，选择2个安全区作为手术通道入口，肿瘤由下向上切除，去髓后断流术是实现最小后退原则的关键。
BackgroundThis study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach.MethodsFrom July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves.ResultsThirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period.ConclusionsWe established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.