改良颞下经岩骨入路显微外科切除岩斜坡区肿瘤20例

Modified Kawase approach for microsurgical removal of petroclival tumors

目的探讨应用改良Kawase入路显微外科切除岩斜坡区肿瘤的疗效和手术方法。方法回顾总结20例采用改良Kawase入路显微外科切除的岩斜坡区肿瘤的临床资料和随访结果。结果本组病例包括脑膜瘤12例、许旺细胞瘤5例、脊索瘤1例、脑桥胶质瘤1例、岩尖表皮样囊肿1例。肿瘤全切除14例，次全切除6例。本组无手术死亡，术后新增神经功能障碍主要是脑神经障碍。结论改良Kawase入路对位于内听道前方的上岩斜坡区肿瘤暴露充分，具有能早期切断岩斜坡区脑膜瘤血运、观察脑干腹侧面和对侧视角更佳、静脉损伤少的优点，可使肿瘤的切除更加安全和彻底。

Objective To discuss the outcome and surgical techniques in patients with petroclival tumors resected microsurgically via modified Kawase approach. Method 20 consecutive petroclival tumors had been resected microsurgically via modified Kawase approach. The clinical data and follow -up results were retrospectively summarized. Results In our series, there were 12 meningiomas,5 schwannomas, 1 chordoma, 1 pontine glioma, 1 petrosal cholesteatoma. Tumor was removed totally in 14 patients, removed subtotally in 6. There was no mortality and the main postoperative new neurological deficit was cranial nerve dysfunction. Conclusions The modified Kawase approach can provide sufficient exposure for tumors in upper petroclival region anterior to internal auditary canal. It has the advantage of early devascularization of petroclival meningioma, better visualization of the contralateral side and the ventral brainstem, less risk of venous complications, all of which facilitates safe and radical removal of the tumor.