经岩骨乙状窦前入路的创伤性及并发症

The surgical trauma and complications in transpetrosal presigmoid approach for removal of petroclival tumors

目的探讨经岩骨乙状窦前入路的创伤性及并发症,为岩斜区肿瘤寻求更合理的治疗手段。方法回顾分析28例采用经岩骨乙状窦前入路手术的岩斜区肿瘤病人的临床表现、影像学特征、手术方法和术后处理等。结果肿瘤全切16例,近全切9例,部份切除3例。术后颅神经症状全缓解5例,症状同术前10例,症状加重10例,昏迷3例。脑脊液耳漏12例。结论经岩骨乙状窦前入路是目前处理岩斜区肿瘤较好的手术入路。但该手术入路创伤性大,并发症较多且严重。

Objective To discuss the surgical trauma and complications in transpetrosal presigmoid approach,in order to seek a rational techniques in the treatment of the petroclival tumors. Methods The clinical and neuroimaglng features, operative approaches and postoperative management of 28 patients were retrospectively summarized. Results Total resection was performed in 16 patients, subtotal resection in 9 patients, partial resection in 3 patients. There were cranial nerve function intact in 5 patients and no change of CN deficit in 10 patients, worsening CN palsies in 10 patients and 3 patients had coma after operation. CSF leaks occured in 12 patients. Conclusion The transpetrosal presigmoid approach has proved to be a better approach to the petroelival tumors at present, but the approach has large trauma and severe complications.