神经内镜经远外侧幕下小脑上入路切除岩斜区肿瘤的临床疗效  

Clinical efficacy of neuroendoscopic resection of petroclival tumors via the far lateral infratentorial supracerebellar approach

作　　者：严正村 张恒柱 王晓东 王杏东 魏民 王广杰 张长福 Yan Zhengcun;Zhang Hengzhu;Wang Xiaodong;Wang Xingdong;Wei Min;Wang Guangjie;Zhang Changfu(Department of Neurosurgery,Clinical Medical College of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院神经外科,扬州225001

出　　处：《中华神经外科杂志》2022年第7期713-717,共5页Chinese Journal of Neurosurgery

基　　金：扬州市第五期"333工程"科研资助 (BRA2019026)。

摘　　要：目的探讨神经内镜经远外侧幕下小脑上入路切除岩斜区肿瘤的临床疗效。方法回顾性分析2020年1月至2021年6月扬州大学临床医学院神经外科采用神经内镜经远外侧幕下小脑上入路切除岩斜区肿瘤患者的临床资料,共15例。其中表皮样囊肿3例,脑膜瘤5例,神经鞘瘤6例,神经纤维瘤1例;后颅窝型9例,中后颅窝骑跨型6例;肿瘤最大径为2.1~4.8 cm。观察术后的疗效及并发症的发生情况。结果15例患者中,肿瘤全切除10例,次全切除5例。术中1例患者发生滑车神经损伤,无一例患者出现小脑挫伤。术后无一例患者发生颅内感染及死亡。术后随访时间为6~24个月,平均12个月。1例患者出现眼球外下活动受限,其余患者均无新增神经功能缺损症状;MRI随访未见肿瘤复发或快速进展。结论神经内镜经远外侧幕下小脑上入路切除岩斜区肿瘤具有创伤小、手术视野广等优点,是治疗岩斜区病变及侵袭中颅窝病变安全、有效的手术方式。Objective To investigate the clinical efficacy of neuroendoscopic resection of petroclival tumors via the far lateral infratentorial supracerebellar approach.Methods A retrospective analysis was performed on the clinical data of 15 patients who underwent neuroendoscopic resection of petroclival tumors via the far lateral infratentorial supracerebellar approach in the Department of Neurosurgery,Clinical Medical College of Yangzhou University from January 2020 to June 2021.Among them,3 cases were epidermoid cysts,5 cases were meningiomas,6 cases were schwannoma,and 1 case was neurofibroma;9 cases were of posterior fossa type,and 6 cases were of middle-posterior fossa straddle type.The tumor diameter ranged from 2.1 to 4.8 cm.Postoperative therapeutic effect and complications were documented.Results Of the 15 patients,10 underwent total tumor resection and 5 underwent subtotal tumor resection.During the operation,trochlear nerve injury occurred in 1 patient,and cerebellar contusion occurred in no patient.There was no intracranial infection or death after operation.The postoperative follow-up time ranged from 6 to 24 months,with an average of 12 months.One patient had limited eye movement to the inferolateral direction,and the other patients had no symptoms of newly-developed neurological deficits,and no tumor recurrence or rapid progression was found in the MRI follow-up.Conclusion Neuroendoscopic resection of petroclival tumors through the far lateral infratentorial supracerebellar approach has the advantages of less trauma and wide surgical field,and is a safe and effective surgical method for the treatment of petroclival lesions and lesions invading the middle cranial fossa.

关 键 词：自然腔道内镜手术 脑肿瘤 岩斜区 远外侧幕下小脑上入路 

分 类 号：R739.41[医药卫生—肿瘤]