经岩骨入路处理岩骨斜坡区肿瘤及血管病变

Transpetrosal surgery of tumorous and vascular lesions of the clivus and juxta clival region

目的：介绍并讨论一种处理斜坡及斜坡旁区肿瘤及血管病变经岩骨手术入路。方法：对２８例病人实施了乙状窦前－迷路后经岩骨幕上下联合入路手术。结果：显微镜下肿瘤全切率８２％，３例桥脑内海绵状血管瘤全部切除，３例基底动脉瘤均成功夹闭。术后４例出现暂时性颅神经损伤症状，１例出现永久性动眼神经损伤症状。颅神经损伤发生率为１８％。２例术后脑脊液漏，２例术后死亡，其余病人恢复良好并均保留了听力。结论：该手术入路的主要优点：对小脑及颞叶牵拉轻；可缩短到达斜坡的距离，并对斜坡区提供良好的暴露，可以保留耳蜗、面神经、横窦。

Objective: To discribe and discuss a transpetrosal approach for tumorous and vascular lesions of clivus and juxta clival region. Methods: 28 patients have been operated on with the combined supra and infratentorial presigmoid retrolabyrinthine transpetrosal approach. Results: 18/22(82%) tumors and 3/3 pontine cavernomas have been totally removed microsurgically with this approach. In all three patients with basilar trank artery aneurysm complete surgical occlusion of the aneurysm via the transpetrosal route was achieved. In one patient persisted paresis of the oculomotor nerve and in 4 patients transient paresis of the other cranial nerves occurred postoperatively. The rate of the cranial nerve injure was 18% postoperatively. CSF leaks were uncommon, occuring in 2 patients. Two patients died during the immediate postoperative period leading to an operative mortality of 7%. In none of the other patients new neurological deficits developed and all of the other patients made a good recovery with preservation of hearing. Conclusions: The advantages were offered by this approach such as the cerebellum and temporal lobes are minimally retracted; the operative distance to the clivus in shortened with exposure of clivus and juxta clival region; the neural and otologic structures, including the cochlea, labyrinth, facial nerve, transverse and sigmoid sinus as well as Labbe's vein can be preserved.