内听道脑膜瘤的诊断与手术策略

doi:10.3877/cma.j.issn.2095-9141.2020.05.012

中华神经创伤外科电子杂志 ›› 2020, Vol. 06 ›› Issue (05) : 308 -311. doi: 10.3877/cma.j.issn.2095-9141.2020.05.012

所属专题：文献；

综述

内听道脑膜瘤的诊断与手术策略

陈立华¹, 张洪钿¹, 孙恺¹, 陈文锦¹, 徐如祥¹^,^†(

)

^1. 610072　成都，四川省医学科学院·四川省人民医院神经外科

收稿日期:2020-03-05 出版日期:2020-10-15
通信作者: 徐如祥

Diagnosis and surgical strategy of internal auditory canal meningioma

Lihua Chen¹, Hongtian Zhang¹, Kai Sun¹, Wenjin Chen¹, Ruxiang Xu¹^,^†()

^1. Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China

Received:2020-03-05 Published:2020-10-15
Corresponding author: Ruxiang Xu
About author:
Corresponding author: Xu Ruxiang, Email: zjxuruxiang@163.com

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内听道脑膜瘤（IAC-M）是桥小脑角脑膜瘤的特殊类型，起源于内听道内的硬膜，主体位于内听道内。术前准确鉴别IAC-M较困难，这是因为内听道的脑膜瘤十分罕见，大部分为个案报道，且报道的IAC-M术前均被误诊为前庭神经鞘瘤，因此术前对于脑膜瘤和听神经瘤的区分很重要，因为肿瘤类型不同，手术入路的选择和手术策略的制定不同。乙状窦后经内听道入路是IAC-M的理想入路，为了降低复发的风险，术中需扩大开放内听道，广泛切除肿瘤，包括肿瘤累及的硬脑膜和骨质。本文就IAC-M的诊断和手术策略作一综述。

关键词: 内听道脑膜瘤, 桥小脑角, 乙状窦后经内听道入路

Internal auditory canal meningioma (IAC-M) is a special type of meningioma in the cerebellopontine angle, it originates from the dura mater in the internal auditory canal and the main body is located in the internal auditory canal. It is difficult to identify IAC-M accurately before operation, this is because IAC-M are very rare and most of them are case reports. All the meningiomas reported in the literature were misdiagnosed as vestibular neurilemmoma before operation. It is important to distinguish meningioma from acoustic neuroma preoperatively, because the choice of surgical approach and the formulation of surgical strategy are different due to different tumor types. The retrosigmoid sinus approach through the internal auditory meatus is an ideal approach for meningiomas of internal auditory meatus. In order to reduce the risk of recurrence, it is necessary to open the internal auditory canal and remove the tumor, including dura and bone involved in the tumor. This article reviews the diagnosis and surgical strategy of IAC-M.

Key words: Internal auditory canal meningioma, Cerebellopontine angle, Retrosigmoid via internal auditory canal approach

表1 内听道内前庭神经鞘瘤与内听道脑膜瘤的切除要点对比

肿瘤	内听道磨除	神经的分离	硬膜处理	颞骨
前庭神经鞘瘤	180°,外侧壁和上壁	沿蛛网膜间隙分离。肿瘤不侵袭蛛网膜，与神经不黏连	肿瘤不侵袭硬膜，无黏连，不处理	正常，不需处理
内听道脑膜瘤	270°,外侧壁和上、下壁	肿瘤侵袭蛛网膜，黏连、甚至侵袭神经	硬脑膜是肿瘤基底，需彻底切除	常受侵袭，需切除

表1 内听道内前庭神经鞘瘤与内听道脑膜瘤的切除要点对比

肿瘤	内听道磨除	神经的分离	硬膜处理	颞骨
前庭神经鞘瘤	180°,外侧壁和上壁	沿蛛网膜间隙分离。肿瘤不侵袭蛛网膜，与神经不黏连	肿瘤不侵袭硬膜，无黏连，不处理	正常，不需处理
内听道脑膜瘤	270°,外侧壁和上、下壁	肿瘤侵袭蛛网膜，黏连、甚至侵袭神经	硬脑膜是肿瘤基底，需彻底切除	常受侵袭，需切除

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Diagnosis and surgical strategy of internal auditory canal meningioma

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