颅后窝胆脂瘤的手术处理

SURGICAL MANAGEMENT OF CHOLESTEATOMA IN THE POSTERIOR CRANIAL FOSSA

本文报道我院近20年收治的162例颅后窝胆脂瘤。男94、女68例,平均年龄41.8(5～73)岁,病程4.5月至18年。平均5.4年。临床主要征象为小脑综合征、眼肌运动障碍、单一或多颅神经麻痹,晚期病例出现颅内压增高症状。根据临床表现及影像学检查作出诊断。全组均行显微外科手术治疗,149例(92％)肿瘤获全切除,余13例(8％)因肿瘤包膜与脑干粘连紧密而行次全切除。手术结果:158例治愈(97.5％),4例于手术后2周内因脑干缺血、水肿或肺部感染死亡(2.5％)。文中对本病的诊断与手术处理原则进行了讨论。

The authors reported 162 patients with cholesteatoma in the posterior cranial fossa admitted between 1978 and 1997. There were 94 males and 68 females. The age was ranged from 5 to 73 years (mean 41.8 years). The clinical course ranged from 4. 5 months to 18 years (mean 5.4 years). The main manifestations of the patients were cerebellar syndrome, oculomotor disorders, paresthesias of one or more cranial nerves and increased intracranial presure during the late term. The diagnosis was made by clinical manifestations and the image materials such as the cerebral angiography, ventriculography, CT scan or MRI. Micro-surgical treatments were performed in all patients of the series, and 149 cases got total removal of the tumor. In the remaining 13 patients, the tumor adhered tightly to the brain stem made only subtotal removal of the capsule of the tumor. Results: 158 cases were cured(97.5%), 4 patients (2.5%) died of brain stem ischemia and edema, or lung infection within two weeks postoperatively. The diagnosis and principles of the surgical management for the disease were discussed in the article.