摘要目的探讨巨大型岩斜脑膜瘤的手术策略。方法回顾性分析32例直径超过4.5 cm的岩斜脑膜瘤患者手术及预后情况。将患者分为枕下乳突后入路组与颅底外科乙状窦前入路组，对其手术时间、肿瘤切除情况、及术后神经功能损伤情况进行对比研究。结果枕下乳突后入路组肿瘤全切除率及次全切除率分别为43%、36%；乙状窦前入路组分别为39%、22%，两组差异无显著性意义（P＞0.05），但枕下乳突后入路组患者神经功能后遗症的发生率较乙状窦前入路组低且症状轻，Karnofsky预后评分较高［枕下乳突后入路组为(75±18)分，乙状窦前入路组为(49±26)分］，两组差异有显著性意义(P＜0.01)。结论巨大型岩斜脑膜瘤患者的肿瘤切除情况与手术入路的选择无明显相关性。枕下乳突后入路手术，在不加重神经功能损伤的前提下，应尽量争取肿瘤全切除；如不能全切除，应缩小瘤体≤3 cm，以利术后放射外科治疗，可能是较为安全有效的治疗方案。

abstractsObjective　To discuss the surgical strategy for giant petroclival meningioma.　Methods　Retrospective analysis of operation and prognosis of 32 patients with petroclival meningioma with a diameter of more than 4.5 cm was carried out.The patients were divided into two groups: suboccipital retromastoid approach and skull base surgical presigmoid sinus approach. Duration of surgery, degree of tumor removal, and postoperative neurological complications were compared between the two groups.　Results　The percentages of radical and subtotal tumor removal in the two groups were not statistically significant. Less time of operations in the presigmoid sinus approach group and mild postoperative neurological sequelae in the suboccipital retromastoid approach group were observed. Karnofsky prognosis scale of the patients at the dismiss time was higher in the suboccipital retromastoid approach group (P＜0.01).　Conclusions　The degree of dissection of giant petroclival meningioma is correlated with tumor nature, blood supply, and adherence to the brain stem. Suboccipital retromastoid approach is suitable for giant petroclival meningioma. Total tumor removal should not increase neurological impairment; if radical dissection is impossible, the tumour may be reduced to less than 3 cm in diameter so as to achieve good results of postoperative radio therapy.