颞底经小脑幕入路显微手术切除岩斜区肿瘤临床研究  

Clinical analysis of using temporal base transtentorial approach to resect tumors in petroclival region

作　　者：易海波[1] 冯睿[2] 林瑞生[1] 王荆夫[1] 于涛[1] 

机构地区：[1]福建医科大学附属漳州市医院神经外科,363000 [2]复旦大学附属华山医院神经外科

出　　处：《中国医师进修杂志》2013年第26期27-30,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨颞底经小脑幕入路切除岩斜区肿瘤的手术方法.方法 回顾性分析26例岩斜区肿瘤患者的临床资料,均采用颞底经小脑幕入路并结合术中电生理监测,分块切除肿瘤位于小脑幕上的部分,然后沿肿瘤与小脑幕边缘切开小脑幕,分块切除小脑幕下肿瘤,肿瘤切除采用分块切除及瘤内切除相结合的方法,减少对周围血管、神经、脑干的牵拉,保护好脑神经及大脑后动脉等重要神经血管,彻底切除肿瘤.观察疗效和并发症.结果 26例患者中肿瘤完全切除19例（73.1％,19/26）,次全切除5例（19.2％,5/26）,大部切除2例（7.7％,2/26）,无死亡病例.11例术后出现部分神经功能障碍.术后随访3个月至4年,3例完全恢复,4例部分恢复,4例为永久性.结论 颞底经小脑幕入路切除,对于岩斜区肿瘤具有操作简单、创伤小、安全性高、肿瘤全切除率高等优点,并结合术中电生理监测是岩斜区尤其中上斜坡区肿瘤显微外科治疗的较理想选择.Objective To discuss the surgical method of resection of petroclival tumors used temporal base transtentorial approach.Methods Analyzed 26 cases of petroclival tumors.All of them were surgically treated under intraoperative neurophysiological monitoring by temporal base transtentorial approach.Firstly the supratentorial part of tumors were resected by pieces,and then the tentorium was cut open,in order to resect residue of the subtentorial part of tumors.This surgical maneuver was applied to reduce the retraction to surrounding vessels,nerves and brain stem,as well to protect important structures and to finally achieve radical removal of the tumors.The efficacy and complications were observed.Results Among 26 cases,19 cases （73.1％,19/26） achieved total removal,5 cases （19.2 ％,5/26） achieved subtotal removal and 2 cases （7.7％,2/26） achieved great partial removal.There was no surgery-related death.Eleven cases suffered from partial neurological deficit.All cases were followed up for 3 months to 4 years,3 cases underwent complete recovery,4 cases underwent partial recovery,and 4 cases underwent permanent deficit.Conclusions Using temporal base transtentorial approach to resect petroclival tumors is convenient,applicable,safe and with minimal injury and with high proportionality of total resection.Under intraoperative neurophysiological monitoring,this approach may be an ideal choice for surgical treatment of these tumors.

关 键 词：显微外科手术 脑肿瘤 岩斜区 

分 类 号：R739.4[医药卫生—肿瘤]