扩大中颅窝硬膜外手术入路的研究与临床应用  

Experimental study and clinical application of extended middle fossa epidural approach

作　　者：李世亭[1] 周良辅[1] 郭欢欢[1] 任力[1] 

机构地区：[1]上海医科大学华山医院神经外科,200040

出　　处：《中华神经外科杂志》1999年第4期205-208,共4页Chinese Journal of Neurosurgery

摘　　要：目的　介绍扩大中颅窝硬膜外手术入路的解剖基础与治疗三叉神经瘤的疗效与体会。方法　在５０ 侧尸体头标本上进行中颅底显微解剖研究， 设计硬膜外手术方案， 并对我科经硬膜内入路和硬膜外入路治疗的９８ 例（１９７８ ～１９９７） 三叉神经瘤病例进行回顾性对比分析。结果　解剖研究与临床应用相结合使硬膜外入路趋于完善。本组病例中５６ 例（５７ ％ ） 肿瘤位于中颅底， ４２ 例（４３ ％ ）呈哑铃型生长。在１９８４ 年以前， 手术采用硬膜内入路， 肿瘤全切率６８ ％ （１９／２８） ， 近全切９ 例。硬膜外入路应用早期（１９８５ ～１９９２） ， 肿瘤全切率７１ ％ （２７／３８） ， 近全切２９ 例， 晚期分别为９１ ％ （２９／３２） 和３ 例， 长期随访中， 硬膜内入路组６ 例死亡， ８ 例复发， 早期硬膜外入路组１ 例死亡， ３ 例复发。三组中颅神经损伤率依次为７０ ％ ， ３４ ％ 和１９ ％ 。结论　扩大中颅窝硬膜外入路是 切除中颅底、海绵窦及中、后颅底哑铃型三叉神经瘤的有效方法。Objective To study the microanatomy of middle cranial fossa and report the operative effect and experience in treating trigeminal neurinomas(TN) via extended middle fossa epidural approach. Methods A microanatomical study was conducted in 50 sides specimens for designing and using middle fossa epidural approach.A retrospective contract review of 98 patients with TN treated via intradural or epidural approach (1978～1997)was undertaken. Results 56 patients(57%) had tumor limited to the middle cranial fossa,42 patients(43%) had both supra and infratentorial components of their tumors. The intradural approach was used only for all tumor removal before 1984 and achieved total tumor removal in 68%(19/28),subtotal in 32%. Since 1985, an epidural approach has been used for all operations and total tumor removal was achieved in 71% (27/38), 91%(29/32)in the early group(1985～1992)and late groups (1993～1997) respectively. During a long term follow up study, 6(21%) patients died and 8(29%) patients suffered recurrence of their tumors in intradural group, while 1 patient died and 3 patients suffered recurrence of their tumors in the early epidural group. Cranial nerves morbidity was 70%, 34%, 19%in intradural group and the early and late epidural groups respectively.Conclusion The extended middle fossa epidural approach is the most effective method to resect the TN involving middle fossa, cavernous sinus or/and upper and middle petroclival region.

关 键 词：硬膜外入路 中颅底 三叉神经瘤 显微外科手术 

分 类 号：R739.430.5[医药卫生—肿瘤]