锁孔入路显微手术切除后颅窝肿瘤的疗效分析  

Microsurgical treatment of posterior cranial fossa tumors via keyhole approaches

作　　者：兰青[1] 钱志远[1] 陈坚[1] 刘士海[1] 陆朝晖[1] 黄强[1] 

机构地区：[1]苏州大学附属第二医院神经外科,215004

出　　处：《中华医学杂志》2005年第4期219-223,共5页National Medical Journal of China

基　　金：江苏省科技厅基金资助项目(BS2002017);江苏省医学重点人才基金资助项目(RC2002019)

摘　　要：目的探讨锁孔手术入路应用于后颅窝肿瘤手术的疗效及手术技巧。方法后颅窝肿瘤患者43例,其中CP角肿瘤20例(听神经瘤18例、脑膜瘤、室管膜瘤各1例)、岩斜区脑膜瘤8例、桥脑肿瘤6例(胶质瘤3例、转移癌2例、胶质增生1例)、四脑室肿瘤4例(髓母细胞瘤、室管膜瘤各2例)、小脑半球肿瘤3例(转移癌2例、血管母细胞瘤1例)、天幕缘脑膜瘤、枕大孔鞍区CP角胆脂瘤各1例。根据肿瘤解剖位置及其特性,选择颞下、乳突后或枕下正中锁孔入路进行手术切除。结果43例肿瘤全切除37例(86.0%),次全切除5例(11.6%),大部分切除1例(2.3%)。无与锁孔入路相关并发症出现。18例听神经瘤患者均肿瘤全切除,面神经解剖保留15例(83.3%),其中1例患者手术后第2天因脑干水肿死亡。8例岩斜区脑膜瘤患者,5例肿瘤全切除,2例次全切除,1例大部分切除,其中2例患者术后遗有轻度偏瘫,1例有轻度面瘫。6例桥脑肿瘤患者,3例肿瘤全切除,3例次全切除,术后无神经功能障碍。其他患者肿瘤均全切除,除1例巨大胆脂瘤患者复视在术后无明显好转外,无其他神经功能障碍。结论锁孔入路进行后颅窝肿瘤手术具有安全、简捷、微创的效果,是神经外科手术发展的一个方向。Objective To explore the surgical outcome and skills of keyhole approaches to posterior cranial fossa tumors. Methods A retrospective analysis of the clinical data of 43 consecutive patients with posterior cranial fossa tumors, including acoustic neurinoma, petroclival meningioma, pons tumor, fourth ventricular tumor, etc. was conducted. Subtemporal, retromastoid, or middle suboccipital keyhole approach was chosen respectively according to the anatomic positions of those different tumors. The length of the incision was about 4 cm, and the diameter of bone window was 2.0-2.5 cm. Normally dura was sutured tightly and no catheter was placed in the surgical fields. Results The tumors were totally removed in 37 of the 43 patients (86.0%), subtotally removed in 5 (11.6%) and mostly removed in 1 (2.3%). There were no complications obviously related to the limited exposure resulting from keyhole approaches. All of the 18 acoustic neurinomas (100%) were totally removed and the facial nerves of 15 patients (83.3%) were preserved anatomically, however, one patient died of brain stem edema on the 2nd postoperative day. Out of the 8 petroclival meningiomas, 5 (62.5%) were resected totally, 2 (25%) subtotally, and 1 (12.5%) grossly. Postoperatively, 2 patients still remained slight hemiparesis, and ~1 presented with mild facial paralysis. Among the 6 pons tumors 3 were removed totally and 3 subtotally. There were no postoperative neurological deficits. All the other tumors were resected completely without neurological dysfunction observed, however, one patient with a cholesteatoma failed to demonstrate apparent improvement in his diplopia. Conclusion Microsurgical treatment of posterior cranial fossa tumors via keyhole approaches, with safe, succinct and minimally invasive property, is one of the promising directions in modern neurosurgery.

关 键 词：后颅窝肿瘤 切除 患者 锁孔入路 术后 转移癌 轻度 干水 特性 选择 

分 类 号：R739.4[医药卫生—肿瘤]