Exploitation of Simple Classification and Space Created by the Tumor for the Treatment of Foramen Magnum Meningiomas.
Exploitation of Simple Classification and Space Created by the Tumor for the Treatment of Foramen Magnum Meningiomas.
复制标题
利用简单分类和肿瘤产生的空间来治疗枕骨大孔脑膜瘤。
DOI：
10.1016/j.wneu.2015.09.022
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Arita K.
中科院分区：
文献类型：
--
作者：
Yamahata H;Yamaguchi S;Takayasu M;Takasaki K;Osuka K;Aoyama M;Yasuda M;Tokimura H;Kurisu K;Arita K.
枕骨大孔区脑膜瘤的切除是神经外科的一大挑战。我们提出了一个简单的分类肿瘤的位置和操作空间创建的肿瘤，以帮助treatmentplanning.MethodsWe回顾性分析了16个FRENTAL，并将它们分为3组的基础上，肿瘤的位置斜坡，椎间孔，和寰椎肿瘤。在枕骨大孔水平测量髁突和神经轴之间的距离，并定义为可用手术空间（AOS）。我们还回顾了术中视频记录，以评估手术暴露的肿瘤的空间所创建的FMM，并将其与AOS.ResultsThere有4斜坡，8椎间孔，和4寰椎肿瘤。斜坡肿瘤的AOS为10 mm ± 1.7，椎间孔肿瘤的AOS为18 mm ± 3.7，寰椎肿瘤的AOS为12 mm ± 2.1。所有的椎间孔和寰椎肿瘤都可以在没有脑牵开器的情况下分离。由于斜坡肿瘤的大部分被脊髓交界处所覆盖，因此需要脑压板来获得所需的手术空间。斜坡和椎间孔/寰椎肿瘤之间的AOS差异有统计学意义（P= 0.044）。尽管4例患者发生了术后并发症，但术后Karnofsky功能量表评分平均改善。手术并发症发生率在椎间孔和寰椎椎明显低于斜坡椎（P= 0.027）。髁突和神经轴之间的FRESH创建的空间的知识对于计划入路策略是有用的，特别是对于估计在不切除枕骨髁的情况下的可用工作空间。
ObjectiveThe resection of foramen magnum meningiomas (FMMs) presents neurosurgical challenges. We propose a simple classification of the tumor location and the operating space created by the tumor to help treatment planning.MethodsWe retrospectively analyzed 16 FMMs and divided them into 3 groups based on the tumor location—clival, foraminal, and atlantal tumors. The distance between the condyle and the neuraxis at the level of the foramen magnum was measured and defined as the available operative space (AOS). We also reviewed intraoperative video recordings to assess the surgical exposure of the tumor by the space created by the FMM and compared it with the AOS.ResultsThere were 4 clival, 8 foraminal, and 4 atlantal tumors. The AOS of the clival tumors was 10 mm ± 1.7, the AOS of the foraminal tumors was 18 mm ± 3.7, and the AOS of the atlantal tumors was 12 mm ± 2.1. All foraminal and atlantal tumors could be detached without a brain retractor. Because a major portion of the clival tumors was covered by the spinomedullary junction, a brain spatula was needed to obtain the required surgical space. The difference in AOS between clival and foraminal/atlantal tumors was statistically significant (P= 0.044). Although 4 patients experienced postoperative complications, the average postoperative Karnofsky performance scale score improved. The surgical complication rate was significantly lower in foraminal and atlantal FMMs than in clival FMMs (P= 0.027).ConclusionsThe simple classification of the tumor location helped to assess surgical difficulties. Knowledge of the space created by the FMMs between the condyle and the neuraxis is useful for planning the approach strategy, especially for estimating the available working space without resection of the occipital condyle.