颞下经小脑幕入路手术切除中上岩斜区肿瘤(附43例报告)  

Subtemporal transtentorial approach for excision of tumors in mid-superior petroclival region: a report of 43 cases

作　　者：邢学民[1] 顾建文[1] 孔滨[1] 匡永勤[1] 贺伟旗[1] 程敬民[1] 杨涛[1] 程林[1] 黄海东[1] 杨文涛[1] 夏勋[1] 马原[1] 赵凯[1] 张修忠[1] 林龙[1] 曾凡俊[1] 

机构地区：[1]成都军区成都总医院神经外科,成都610083

出　　处：《解放军医学杂志》2011年第4期385-386,392,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨颞下经小脑幕入路切除中上岩斜区肿瘤的手术技巧。方法回顾性分析2003年6月-2010年4月收治的43例中上岩斜区肿瘤,其中男19例,女24例,年龄23～64岁,平均42岁,病程2个月～3年,平均14个月,均采用颞下经小脑幕入路,对肿瘤与中上岩斜区毗邻结构关系进行评估,分离肿瘤与天幕及岩斜部脑膜的近端粘连,由近及远分块切除肿瘤,逐渐分离扩大脑干、下视丘、海绵窦与肿瘤之间的间隙,避免直接接触上述重要结构,彻底切除肿瘤。观察术后疗效和并发症。结果 43例患者中肿瘤完全切除31例(72.1%),次全切除7例(16.3%),大部切除5例(11.6%),死亡1例(2.3%)。23例术后出现部分神经功能障碍。术后随访3～48个月,神经功能障碍均得到不同程度恢复。结论颞下经小脑幕入路切除中上岩斜区肿瘤具有手术路径短、容易暴露的优点。缩小肿瘤体积、扩大操作空间是此类手术的关键。Objective To explore the surgical technique for excision of mid-superior petroclival region tumor through subtemporal transtentorial approach.Methods Forty-three patients with tumor at superior-middle petroclival region hospitalized from Jun.20003 to Apr.2010 were involved in present study,and their clinical data were retrospectively analyzed.Of the 43 patients,19 were male and 24 were female,age ranged from 23 to 64 years（with mean of 42 years）,disease duration ranged from 2 months to 3 years（with average of 14 months）.All the patients underwent tumor resection via subtemporal transtentorial approach.The relationship between tumors and adjacent superior-middle petroclival structures was evaluated,and then the adhesion between tumor and tentorium cerebelli or petroclival meninges was separated,the tumor was resected piecemeal from closest area to distant part.The arachnoidal planes between tumor and brain stem,hypothalamus,or cavernous was dissected to enlarge the gap between the tumor and brain tissue,at the same time avoiding irritation to the above important structures.The therapeutic effects and postoperative complications were recorded.Results Total resection was achieved in 31 cases（72.1%）,subtotal resection in 7 cases（16.2%）,and partial resection in 5 cases（11.6%）.One patient died（3.3%）.Twenty-three patients developed new postoperative neurological deficits.The patients were followed up for 3 to 48 months,and the neurological functions were found to recover in varying degrees.Conclusion Subtemporal transtentorial approach for excision of tumors at superior-middle petroclival region has advantages of shorter approach and easy to expose.The key of the operative procedure is to reduce the tumor volume and enlarge the operative space.

关 键 词：显微外科手术 神经外科手术 脑肿瘤 岩斜区 

分 类 号：R739.410.5[医药卫生—肿瘤]