Objective: To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas. Methods: From January 2011 to December 2016, a cohort of 28 patients with medial tentorial meningiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University. Patients who treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group, and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group. The surgical approaches tailored in our patients were based on predominant direction of tumor extension. The extent of tumor resection was scored according to the Simpson's classification scale. Comparisons of tumor size, operation time, hospitalization time, retraction-related injury, tumor Simpson resection grade and Karnofsky Performance Scale(KPS) score six months after surgery were also made between two groups. Results: A total of 12 patients(retractor group) were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group). The difference between two groups with regard to sex, age, tumor size, operation time and tumor Simpson resection grade was not statistically significant(all P>0.05). The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3 d±1.8 d vs 20.2 d±1.3 d, P=0.004). The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group(1/16 vs 6/12), P=0.022]. The dynamic retraction group had better neurological recovery rate with KPS >80 evaluated six months after surgery compared with the retractor group(14/16 vs 5/12, P=0.017). Conclusions: Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible, which can obviate or reduce the amount of brain retraction needed, and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.
目的：探讨动态牵拉显微神经外科手术治疗内侧型小脑幕脑膜瘤的疗效和临床意义。 方法：对重庆医科大学附属第一医院神经外科从2011年1月至2016年12月显微神经外科手术治疗28例内侧型小脑幕脑膜瘤的临床资料进行回顾性分析。将2011年1月至2013年12月所有术中采用牵开器牵拉手术的患者分为常规牵拉组，将2014年1月至2016年12月所有术中采用动态牵拉手术的患者分为动态牵拉组。手术入路的设计取决于肿瘤的主体位置。肿瘤切除程度采用Simpson肿瘤切除分级标准。分析和比较两组患者肿瘤大小、手术时间、住院时间、脑牵拉损伤、肿瘤Simpson切除程度以及术后6个月KPS评分。 结果：共12例患者(常规牵拉组)术中采用脑自动牵开器手术，16例患者(动态牵拉组)术中采用了动态牵拉手术。两组患者在性别、年龄、肿瘤大小、手术时间及肿瘤Simpson切除程度方面的差异均无统计学意义(均P>0.05)。平均住院时间动态牵拉组小于常规牵拉组(分别为18.3 d±1.8 d、20.2 d±1.3 d，P＝0.004)；动态牵拉组术后脑牵拉损伤并发症发生比例显著低于常规牵拉组(分别为1/16及6/12，P＝0.022)；术后6个月神经功能恢复比例(KPS>80分)动态牵拉组显著高于常规牵拉组(分别为14/16及5/12，P＝0.017)。 结论：动态牵拉显微神经外科手术治疗内侧型小脑幕脑膜瘤是可行的，并能避免或减少脑自动牵开器的使用，降低术后神经损伤和并发症的风险，减少住院费用和改善患者预后。.
Keywords: Dynamic retraction surgery; Microneurosurgery; Self-retaining retractor; Tentorial meningiomas.