后岩面脑膜瘤的经迷路径路切除术：手术、功能及肿瘤学结局及其与解剖扩展和肿瘤负荷的关联

文献信息

中文摘要

背景/目的： 经迷路径路（TL）手术已确立用于前庭神经鞘瘤，但其在同质性后岩面脑膜瘤（PPFM）队列中的作用仍未明确。我们描述了手术、功能及肿瘤学结局，并探讨其与肿瘤扩展和肿瘤负荷的关联。方法：我们回顾性分析了2006年至2024年在单一机构接受单纯TL切除术的14例患者。岩骨区（前、中、后）分别独立建模。结局包括切除范围、Simpson分级、并发症、肿瘤控制、House-Brackmann（HB）面神经（FN）分级、改良Rankin量表（mRS）和格拉斯哥结局量表（GOS）。结果：术前，10例（71.4%）存在不可用或缺失听力，中位直径为33.5 mm。85.7%实现大体或近全切除（中位切除范围96.2%）。1年时，14例中13例（92.9%）为HB I-II级，包括所有12例术前功能良好者；所有患者均获得良好结局（mRS 0-2；GOS 4-5）。在中位65.5个月随访中，发生1例复发和3例再生长，5例（35.7%）接受辅助放疗。在探索性分析中，前部受累与Simpson 1-2级切除可能性较低相关（p = 0.025），但与体积切除范围无关；肿瘤直径与并发症负担相关（ρ = 0.585；p = 0.028），肿瘤体积与手术时间（ρ = 0.607；p = 0.021）和住院时间（ρ = 0.753；p = 0.002）相关。结论：在这个首个单纯TL的PPFM系列中，面神经和功能结局良好，在多模式管理下肿瘤控制可接受。这些发现描述了在适当选择的患者中通过TL通道可实现的结局，而非优于其他入路。前部扩展、肿瘤负荷与结局之间的探索性关联需要在更大队列中确认。

英文摘要

Background/Objectives: Translabyrinthine (TL) surgery is established for vestibular schwannomas, but its role in a homogeneous posterior petrous face meningioma (PPFM) cohort remains undefined. We characterized surgical, functional, and oncological outcomes and associations with extension and tumor burden. Methods: We retrospectively reviewed 14 patients undergoing TL-only resection at a single institution (2006-2024). Petrosal zones (anterior, middle, posterior) were modeled independently. Outcomes included extent of resection, Simpson grade, complications, tumor control, House-Brackmann (HB) facial nerve (FN) grade, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GOS). Results: Preoperatively, 10 (71.4%) had non-serviceable or absent hearing, and the median diameter was 33.5 mm. Gross or near-total resection was achieved in 85.7% (median extent, 96.2%). At 1 year, 13 of 14 (92.9%) had HB I-II, including all 12 with favorable preoperative function; all had favorable outcomes (mRS 0-2; GOS 4-5). Over a median 65.5-month follow-up, one recurrence and three regrowths occurred, with five patients (35.7%) receiving adjuvant radiation. In exploratory analyses, anterior involvement was associated with a lower likelihood of Simpson grade 1-2 resection (p = 0.025), but not with volumetric extent; tumor diameter correlated with complication burden (ρ = 0.585; p = 0.028), and tumor volume correlated with operative duration (ρ = 0.607; p = 0.021) and hospital stay (ρ = 0.753; p = 0.002). Conclusions: In this first TL-only PPFM series, FN and functional outcomes were favorable and tumor control was acceptable under multimodal management. These findings describe outcomes achievable through the TL corridor in appropriately selected patients rather than an advantage over alternative approaches. Exploratory associations between anterior extension, tumor burden, and outcome require confirmation in larger cohorts.