颞下小骨窗入路显微手术临床应用

Clinical application of modified subtemporal approach in microsurgery

目的改良常规颞下入路,以减少手术创伤达到微创的目的。方法采用耳前1cm颧弓向上向后弧形切口,绕行耳廓上方约1cm到达乳突,铣开4cm×2cm大小骨窗,平中颅底,经颞下行中颅底部位病灶的手术治疗l5例。结果9例三叉神经鞘瘤全切除8例,次全切l例。4例岩尖区天幕下脑膜瘤和2例颞底胶质瘤均全切除。结论颞下小骨窗入路可以达到常规颞下入路的效果,可以满足中颅窝后部、颞叶底面及天幕区的肿瘤切除术的要求,是一种行之有效的微创手术入路。

Objective To modify the regular subtemporal approach using smaller bone opening to reduce surgical trauma. Methods A curved skin incision start from the zygomatic arch （1 cm in front of the ear） to the mastoid, just lcm above the auricle. Afterwards, a 4cm ×2cm craniotomy was performed to expose the middle cranial fossa. 15 operations via this modified subtemporal approach were performed to deal with tumors located in middle cranial fossa region. Results Among 9 cases of trigeminal neurinoma, 8 of them received total resection, 1 case received subtotal resection. 4 cases of infratentorial meningioma at the petrous apex area, and 2 cases of temporal glioma received total resection. Conclusion This modified subtemporal approach has the same exposure as the normal approach, which meets the needs of removing tumors located in posterior part of middle cranial fossa, subtemporal area, and infratentorial area.