岩斜区肿瘤的手术入路选择

Surgical approaches for the treatment of petroclival tumors

目的探讨岩斜区肿瘤的手术入路选择,以提高岩斜区肿瘤的手术疗效。方法回顾性分析2000年1月至2009年12月经显微外科技术切除的92例岩斜区肿瘤,比较手术入路对手术结果的影响。根据肿瘤的临床和影像学特征,将岩斜区肿瘤分为四型。Ⅰ型,采用颞下-经天幕入路;Ⅱ型,采用颞下-经岩骨嵴入路,另有3例巨大型蝶岩斜坡型脑膜瘤采用经岩入路(幕上幕下联合或乙状窦前入路);Ⅲa,采用枕下乙状窦后入路;Ⅲb,采用乙状窦后-内听道上入路;Ⅳ型,经鼻-蝶入路切除。结果肿瘤SimpsonⅠ～Ⅱ级全切除83例。次全切除9例,其中Ⅰ型1例,Ⅱ型5例,Ⅲb型1例,Ⅳ型2例。术后新增脑神经功能障碍16例(17.4%),肢体偏瘫2例;另有2例KPS评分为50分,这2例随访3个月后基本恢复至术前状态。无死亡病例。结论对于不同类型的岩斜区肿瘤,选择合适的手术入路有助于提高疗效,减少术后并发症。乙状窦后及其改良入路、颞下-经天幕及其改良入路是岩斜区重要的手术入路。而硬膜外岩斜区肿瘤适合于采用经蝶入路手术切除。

Objective To investigate the surgical approaches for the treatment of petroclvial tumors in order to improve the surgical effect.Methods The clinical data of 92 patients with the petroclival tumors,treated from January 2000 to December 2009,were analyzed retrospectively to compare the effect of different surgical approaches for pertroclival tumors.According to the clinical features and imaging characteristics,92 cases with petroclival tumors were divided into four groups： subtemporal transtentorial approach was suggested for type Ⅰ petroclival tumors;subtemporal transpetrosal ridge approach for type Ⅱ tumors,including transpetrosal approach（combined supra-and infra-tentorial or presigmoid approach） for 3 cases with giant petroclival meningioma;suboccipital retrosigmoid approach for type Ⅲa tumors;suboccipital retrosigmoid suprameatal approach for type Ⅲb tumors and transsphenoidal approach for type Ⅳ tumors.Results Simpson I or Ⅱ resection was achieved in 83 cases.Simpson Ⅲ resection was achieved in 9 cases,including 1 case of type Ⅰ,5 cases of type Ⅱ,1 case of type Ⅲb and 2 cases of type Ⅳ.The new cranial nerve deficits occurred in 16 patients after the operation（17.4%）,and transient hemiplegia was observed in 2 patients.Post-operative KPS of 50 was observed in 2 cases and was improved gradually during the 3 months＇ follow-up.No dead case occurred.Conclusion Suitable surgical approaches should be chosen according to different types of petroclival tumors,which is important to increase the therapeutic efficacy and decrease the postoperative complications.Suboccipital retrosigmoid,suboccipital retrosigmoid suprameatal approach and the modified approaches are the crucial surgical approaches for petroclival tumors.For the extradural tumors,the transsphenoidal approach is recommended.