颞下-乙状窦前入路切除天幕游离缘中区脑膜瘤(附11例报道)  

Subtemporal-Presigmoid Sinus Approach to The Free Tentorial Incisura Middle Area Meingioma(11 cases experience)

作　　者：张晓华[1] 葛建伟[1] 李善泉[1] 熊文浩[1] 邱永明[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,上海200127

出　　处：《立体定向和功能性神经外科杂志》2008年第2期94-98,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨天幕游离缘中区脑膜瘤切除的手术方法和入路。方法应用颞下-乙状窦前入路,磨除岩骨极限化暴露乙状窦前间隙,剪开天幕的同时根据肿瘤分型采用不同方式处理肿瘤附着点,将肿瘤及其附着天幕一并切除。结果11例脑膜瘤获得SimpsonⅠ级切除8例,SimpsonⅡ级切除2例,SimpsonIⅢ级1例;术后有2例出现轻度滑车神经麻痹,1例出现面部麻木,均1个月后恢复;平均随访21.2个月,随访期间无肿瘤复发。结论采用颞下-乙状窦前入路切除天幕游离缘区肿瘤可以在最小牵拉颞底和小脑的同时很好的处理肿瘤基底,同时切除肿瘤附着的硬膜和保留颅神经功能的完整,从而获得最大限度的肿瘤切除,但对于跨中线生长的肿瘤该入路有一定的局限性。Objective To investigate the operation method and appraoch for meingiomas located in free tentourian incisura middle area. Methods These meingiomas were classified as originating from their development manner and were removed by subtemproal-presigmoid sinus approach, the presigmoid space was exposed maximally by drilling the petrous bone, and then the tentorium was incised and removing the tumor and the involved dura by different methods according to the meingioma type. Results 8 cases were removed in Simpson grade Ⅰ, 2 cases were removed in Simpson gradeⅡ, one in Simpson grade Ⅲ. One patient had the episode of the partial temporal and occipital lobe edma but recovered by drug therapy, two patients suffered from mild abducens nerve palsy and one in facial numberness, all recovered 1 month post-operation. The average following-up time is 21.2 months, no tumor recurrence occurs during the following-up period. Conclusion Removing the meingioma via subtemproal-labyrinth presigmoid sinus approach can dispose the tumor base with lesser retracting the temporal lobe bottom and cerebellum, simultaneously removing the dura invasived by the tumor and keeping the cranial nerve intergrity, accordingly total removing the tumor, but if the tumor is over midline, this approach will show its limitation.

关 键 词：脑膜瘤 岩骨 颞下-乙状窦前入路 天幕游离缘 

分 类 号：R739.45[医药卫生—肿瘤]