Abstract:
Skull base meningiomas are among the most challenging meningiomas to treat clinically due to their deep location, involvement or encasement of adjacent essential neurovascular structures (such as key arteries, cranial nerves, veins, and venous sinuses), and their often-large size prior to diagnosis. Although multimodal treatment strategies continue to evolve with advances in stereotactic and fractionated radiotherapy, surgical resection remains the mainstay of treatment for these tumors. Resection of these tumors however is challenging from a technical standpoint, and requires expertise in several skull-base surgical approaches that rely on adequate bony removal, minimization of brain retraction, and respect for nearby neurovascular structures. These skull base meningiomas originate from a variety of different structures including, but are not limited to: the clinoid processes, tuberculum sellae, dorsum sellae, sphenoid wing, petrous/petroclival area, falcotentorial region, cerebellopontine angle, and foramen magnum. In this chapter, we will cover the common anatomical areas in the skull base from which these tumors arise, and the specific or optimal surgical approaches and other treatment modalities for meningiomas in these such locations.
摘要:
颅底脑膜瘤是临床治疗最具挑战性的脑膜瘤之一,受累或包裹相邻的基本神经血管结构(如关键动脉,颅神经,静脉,和静脉窦),以及它们在诊断前通常很大的尺寸。尽管随着立体定向和分割放射治疗的进展,多模式治疗策略继续发展,手术切除仍然是治疗这些肿瘤的主要手段。然而,从技术角度来看,切除这些肿瘤是具有挑战性的,并且需要几种颅底手术方法的专业知识,这些方法依赖于充分的骨切除,大脑收缩的最小化,尊重附近的神经血管结构。这些颅底脑膜瘤起源于各种不同的结构,包括,但不限于:临床过程,鞍结节,背宫,蝶骨翼,岩层/岩层区域,伪造地区,小脑桥脑角,大孔.在这一章中,我们将覆盖这些肿瘤产生的颅底常见解剖区域,以及这些位置脑膜瘤的特定或最佳手术方法和其他治疗方式。