幕上下经岩骨乙状窦前入路切除巨大岩斜部肿瘤

Transpetrosal presigmoid approach for removal of giant petroclival tumors

目的 探讨幕上下经岩骨乙状窦前入路切除岩斜部肿瘤手术的技巧及并发症。 方法 取颞枕游离骨瓣，分别于迷路前后将乳突及岩骨根部大部切除，但保留骨性半规管、耳蜗及鼓室的完整性；结扎并切断岩上窦，自乙状窦前方抵达岩斜部。 结果 ４１ 例肿瘤包括脑膜瘤２０ 例，表皮样囊肿２０ 例，神经鞘瘤１ 例。手术全切肿瘤３４ 例，近全切除６ 例，大部切除１ 例。术后一过性失语１０例，脑水肿６ 例，脑干梗塞２ 例，第Ⅲ、Ⅵ、Ⅶ及后组颅神经损伤分别为１６ 、１６、８ 及６ 例，脑脊液耳漏４例。无死亡。 结论 该入路可充分显露岩骨尖及斜坡区，并可较好地暴露鞍旁、脚间窝和枕大孔区以及同侧的第Ⅲ～Ⅻ颅神经。术后并发症多与手术操作技巧及肿瘤特性有关。

Objective To discuss the operative technique, advantage and postoperative complications in 41 patients with giant petroclival tumors treated with the supra and infratentorial transpetrousal presigmoid approach. Methods Clinical data were obtained from the review of charts and radiographic images of the 41 patients after operation with temporo occipotal free osseous flap, partial petrosectomy and mastoidectomy were performed around the labyrinth. The semicircular canals, cochlea and tympanic cavity were protected during the operation. After the super petrous was ligated and cut off, the petroclival region in front of the sigmoiid sinus was exposed. Results In the 41 patients 20 had meningiomas, 20 epidermoid cysts, and one schwannoma. Total resection was performed in 34 patients, subtotal resection in 16, and greater partial resection in one. Major postoperative complications included temporal aphasia (10 patients), cerebral edema (6), brain stem infarct (2), Ⅲth,Ⅶth,Ⅵth and posterial group cranial nerves palsies (16,16,8,6 respectively), and cerebrospinal fluid leakage (4 cases). Conclusions This approach can expose sufficiently the petroclival region. It can also reveal the area of adjacent sella, interpeduncular and formen magnum, and homolateral Ⅲ Ⅻth cranial nerves. The postoperative complications may be related to operative techniues and tumorous characteristics.