岩斜区肿瘤手术入路选择的探讨  

Choice of the surgical approach to petroclival tumor

作　　者：施炜[1] 徐启武[1] 车晓明[1] 胡杰[1] 顾士欣[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华外科杂志》2006年第2期126-128,共3页Chinese Journal of Surgery

摘　　要：目的探讨岩斜区肿瘤的手术入路选择。对53例岩斜区肿瘤患者的手术治疗进行分析。方法患者采用颞底经天幕入路11例,枕下乙状窦后入路12例;(颧弓或眶颧)翼点入路12例;乙状窦前入路2例;颞底、乙状窦后幕上下联合入路7例;颞下前岩骨硬膜外入路7例;扩大的前颅底硬膜外入路2例。结果32例(61%)患者肿瘤全切除,9例(17%)次全切除,12例(22%)大部切除。术后新发生颅神经功能障碍16例(30%),死亡2例(4%)。结论枕下乙状窦后入路、颞底经天幕入路等岩斜区手术入路均可以在熟练的显微操作技术及神经导航、神经内镜下进行。主体生长于硬膜外的岩斜肿瘤适合于采用硬膜外入路手术切除。幕上下联合入路对巨大岩斜区肿瘤是理想的手术入路。Objective To discuss the reasonable choice of the surgical approach to petroclvial tumors. Methods The clinical data of consecutive 53 patients with the petroclival tumors, treated from June 2002 to June 2004, were reviewed to compare the different surgical approaches to pertroclival region. Result Subtemporal transtentorial approach were used in 11 patients, suboccipital retrosigmoid approach in 12 patients, （ transzygomatic or orbitozygomatic ） frontotemporal （ pterional ） approach in 12 patients, presigmoid sinus approach in 2 patients, subtemporal and retrosigmoid sinus combined approach in 7 patients, subtemporal anterior petrosal extradural approach in 7 patients and extended transfrontal base extradural approach in 2 patients. Of all patients in this group, total tumor removal was achieved in 32 patients, subtotal in 9, largely partial in 12. The new cranial nerve deficit took place in 16 patients postoperatively, two patients died from coma and serious pneumonia.Conclusions Using perfect microsurgical technique, conventional surgical approaches on petroclival region such as suboccipital retrosigmoid approach, subtemproal transtentoiral approach can be suitable for most petroclival tumor with the help of neuro-navgation and neuroendoscope. To the epidural tumor on petroclival region, the epidural approach should be used with less invasion to the brain tissue. And to the giant petroclival tumor, the combinted-tentorial approach can provide an excellent access and exposure to the tumor.

关 键 词：显微外科手术 岩斜区肿瘤 手术入路 

分 类 号：R739.4[医药卫生—肿瘤]