经髁后入路显微手术切除枕骨大孔腹侧或腹外侧脑膜瘤

目的评价枕大孔(FM)腹侧或腹外侧脑膜瘤手术入路及治疗策略变化。方法回顾性分析解放军总医院2007年1月—2022年1月采用显微外科技术切除的72例枕大孔腹侧或腹外侧脑膜瘤的临床资料，并结合相关文献进行复习。结果所有患者均经一侧远外侧髁后入路显微手术切除。全切除 65例（90%），次全切除7例（10%)。次全切除的患者行赛博刀放射外科治疗。12例（17%）发生舌下神经功能障碍，8例术后3个月内好转。18例（25%）出现声音嘶哑和(或）吞咽困难，15例在术后3个月内好转，1例患者因后组颅神经麻痹而行气管切开。1例因脊髓前动脉损伤偏瘫。无手术死亡。随访12～60个月，无患者出现肿瘤复发。结论经髁后入路显微手术切除枕骨大孔腹侧或腹外脑膜瘤既能满足手术显露需要，又避免了磨除过多的骨质，可取得很好的全切率、较低的并发症和长期满意疗效。术后偏瘫等严重并发症的发生主要是因为术中血管损伤。

Objective To evaluate the changes in surgical approaches and treatment strategies for foramen magnum(FM) meningiomas located in the anterior or anterolateral aspect of the medulla oblongata. Methods The clinical data of 72 patients suffering a meningioma attached to dura of the anterior or anterolateral FM rim admitted to General Hospital of the People’s Liberation Army from January 2007 to January 2022 were analyzed retrospectively. The relevant literature were reviewed. Results Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. Total resection was achieved in 65 patients(90%). 7 patients(10%) of subtotal resection underwent cyberknife radiosurgery. 12 cases(17%) had hypoglossal nerve dysfunction, and 8 improved within 3 months after surgery. 18 cases(25%) experienced hoarseness and/or difficulty swallowing, 15 improved within 3 months after surgery, and 1 underwent tracheotomy due to posterior cranial nerve paralysis. 1 suffered from hemiplegia due to anterior spinal artery injury. There were no surgical deaths. No tumor recurrence was observed after a mean follow-up period of 3 years(range, 12-60 months) with clinical and MRI examination. Conclusions Microsurgery via retrocondylar approach to remove anterior and anterolateral FM meningiomas can not only meet the needs of surgical exposure, but also avoid excessive bone grinding, achieving good total resection rate, low complications, and long-term satisfactory therapeutic effect. The occurrence of serious complications such as postoperative hemiplegia is mainly due to intraoperative vascular damage.