Abstract: Objective To investigate the main surgical methods and curative effects of microsurgical resection of meningioma in the foramen magnum via posterior median approach.To explore the nerve and vascular protection strategies combined with neuronavigation and neuroendoscopy.Methods We followed up 15patients with meningioma in the foramen magnum who received tumor resection via posterior median approach in our department from January2017 to June 2022.Neuronavigation and neuroendoscopywere used to protect ventral blood vessels and nerve tissues of brain stemduring tumor resection.Results A total of 15 cases was followed up in this group.However,Total resection of tumor was performed in 11 cases and subtotal resection was performed in 4 cases.Preoperative symptoms included neck and shoulder numbness,upper limb weakness,drinking cough and walking instability.There were 9 cases of complete remission,2 cases of improvement,4 cases of maintenance or aggravation,and no new symptoms were observed during the follow-up for 0.5 to 6 years.No cerebrospinal fluid leakage,infection and death occurred in this group.Conclusion Posterior median approach microsurgical resection of meningioma in the foramen magnum is effective.Neuronavigation and neuroendoscopy can effectively prevent brain stem and vascular nerve injury.

Key words: Meningiomain the foramen magnum, Microsurgical resection, Posterior median approach

摘要： 目的 探讨经后正中入路显微手术切除枕骨大孔区脑膜瘤的手术要点及疗效,研究延髓神经及血管保护策略。方法 回顾2017年1月~2022年6月收治15例枕骨大孔区脑膜瘤病例,采用后路正中入路显微切除肿瘤,术中结合神经导航及进行神经及血管保护,必要时应用神经内镜切除肿瘤并保护脑干腹侧血管及神经组织,分析手术疗效及并发症发生情况。结果 本组病例15例,全切11例,次全切4例。术前存在症状如颈肩部麻木、上肢无力、饮水呛咳及行走不稳等症状,其中完全缓解9例,好转2例,维持或加重4例,随访0.5~6年均未出现新发症状。本组无脑脊液漏及感染、死亡发生。结论 个体化后正中入路显微手术切除枕骨大孔区脑膜瘤疗效确切,神经导航及神经内镜辅助可有效防止脑干及血管神经损伤。

关键词: 枕骨大孔区脑膜瘤, 显微外科治疗, 后正中入路