中颅底至颞下窝、翼腭窝沟通性肿瘤的手术治疗  

Surgical management of middle skull base tumor communicating infratemporal and pterygopalatine fossa

作　　者：王旭辉 贺绪智 任明亮 梁鸿 许明伟 李兵 王昊 许民辉 周椿 徐伦山 WANG Xu-hui;HE Xu-zhi;REN Ming-liang(Department of Neurosurgery, Army Characteristic Medical Center, Chongqing 400042, China)

机构地区：[1]陆军特色医学中心神经外科,重庆400042

出　　处：《临床神经外科杂志》2020年第3期259-263,共5页Journal of Clinical Neurosurgery

基　　金：重庆市基础研究与前沿探索(CSTC2017JCYJAX0337)。

摘　　要：目的探讨中颅底至下方毗邻的颞下窝、翼腭窝沟通性肿瘤的外科手术治疗方法、技术和效果。方法陆军特色医学中心神经外科2013年—2018年收治的17例中颅底至颞下窝、翼腭窝沟通性肿瘤患者。其中4例患者经翼点、1例患者经鼻内镜、12例患者经眶颧或耳前颧弓入路手术切除肿瘤。患者术后定期复查CT及MRI;并予以门诊及电话随访。结果本组患者中,术后病理检查示恶性肿瘤4例、交界性肿瘤3例、良性肿瘤10例。10例良性肿瘤患者中,肿瘤全切者8例,部分切除1例,仅行活检者1例。3例交界性肿瘤患者均达到肿瘤全切;4例恶性肿瘤患者中,全切者2例,部分切除者2例。术后,出现脑脊液漏及颅内感染者2例,其中1例患者发展为脑积水;动眼神经损伤1例,一过性面瘫1例,一过性面部麻木1例;2例患者遗留轻度面部麻木。CT及MRI复查示,16例患者无肿瘤复发(或明显进展),1例恶性肿瘤患者的残余肿瘤明显进展。结论中颅底至颞下窝、翼腭窝沟通性肿瘤中的良性肿瘤多可通过耳前经颧弓入路切除,效果良好。对于恶性肿瘤采用更为激进的入路,争取整块切除,或可获得良好的预后。该区域结构复杂,病变起源多样,多学科联合手术更为可行。Objective To study the surgical treatment,techniques and outcomes of the middle skull base tumors communicating adjacent inferior temporal fossa(ITF)and pterygopalatine fossa(PPF).Methods From 2013 to 2018,the Army Medical Center admitted 17 patients with tumors communicate the middle skull base and ITF and/or PPF.Among these surgeries,pterion approach was adopted in 4 cases,transnasal endoscopic approach in 1 and orbital-zygomatic approach or preauricular trans-zygomatic approach in 12.Postopratively,the patients were suggested to undergo CT or MR regularly and followed up clinically or through the telephone.Results In this group,postoperative pathological outcomes indicated 4 malignant,3 borderline,10 benign tumors.Among the 10 patients with benign tumor,8 had total tumor resection,1 had partial resection,and 1 had biopsy only.All 3 patients with borderline tumor had complete tumor resection.Among the 4 patients with malignant tumor,2 had total resection and 2 had partial resection.Postoperative cerebrospinal fluid leakage and intracranial infection occurred in 2 patients,1 of whom developed hydrocephalus.There were 1 case of oculomotor nerve injury,1 case of transient facial paralysis,and 1 case of transient facial numbness.2 patients were left with mild facial numbness.Conclusions The benign tumors in the communication tumors from the middle skull base to ITF and/or PPF can be mostly resected through the preauricular trans-zygomatic approach with good outcomes.For malignancies,a more aggressive approach,aimed at the en bloc excision,may yield a favorable prognosis.Due to the complex anatomical structures in the region,and the diverse origin of the lesions,multidisciplinary surgery should be more feasible.

关 键 词：颅底肿瘤 颅内外沟通 中颅底 颞下窝 翼腭窝 

分 类 号：R739.41[医药卫生—肿瘤]