颅中窝进路岩尖胆脂瘤切除术

Resection of petrous apex cholesteatoma through middle cranial fossa approach

目的探讨颅中窝进路岩尖胆脂瘤切除术的适应症、手术方法和手术效果。方法对1997年1月—2007年4月收治6例(耳)岩尖胆脂瘤(5耳先天性,1耳后天性)行颅中窝进路胆脂瘤切除术。结果6耳岩尖胆脂瘤均能全部切除,术后随访1￣10年无复发。术前纯音测听呈中度混合性聋2耳,中度感音神经性聋1耳,中重度感音神经性聋3耳,术后基本能保存术前听力水平。4例术前面瘫患者中有3例行面神经减压,其中2例由Ⅲ级(House-Brackmann分级)恢复至Ⅰ级,1例由Ⅳ级恢复至Ⅲ级;1例面神经端端吻合由VI级恢复至IV级。结论颅中窝进路能保留患耳的听力,对于听力损失较少或胆脂瘤较局限的先天性胆脂瘤,颅中窝进路是较合适的进路。

Objective To review the indications, surgical techniques and surgical outcomes for resection of petrous apex cholesteatoma through a middle cranial fossa approach. Methods Six cases （ears ） with petrous apex cholesteatoma hospitalized between January 1997 and April 2007, including 5 ears with congenital cholesteatoma and one acquired cholesteatoma, were operated on through the middle cranial fossa approach. Results The cholesteatoma of all cases can be totally resected, without recurrence in a follow-up of 1 to 10 years. Preoperative pure tone audiometry show that 2 cases had moderate mixed deafness, one moderate sensorineural deafness and three moderate to severe sensorineural deafness. The preoperative residual bone conduction hearing can be preserved basically in all cases. Of the four cases with facial paralysis, 3 received facial nerve decompression, 2 of whom recovered from House-Brackmann grade Ⅲ to gradeⅠand one from grade Ⅳ to grade Ⅲ. One case who received end-to-end anastomosis recovered from grade Ⅵ to grade Ⅳ . Conclusion Middle cranial fossa approach can preserve residual hearing and is suitable for cases with a small congenital cholesteatoma and mild hearing loss.