侧颅底疾病的外科治疗及颅底重建(附20例报告)

Surgical teatment of communicative lateral skull base diseases(A report of 20 cases)

目的探讨侧颅底疾变的外科治疗和体会。方法回顾性分析20例侧颅底疾病患者的临床资料,其中颞骨占位性病变破坏内听道、颈静脉孔区等占位病变与颅内沟通者1 1例,采取经迷路、乳突腔引流以及经乳突切除肿瘤手术;中耳炎性疾病破坏鼓室、鼓窦天盖与颅内沟通者2例,采取扩大乳突根治手术;外伤与畸形造成侧颅底骨质破坏,脑脊液耳漏、鼻漏7例,采取经迷路、乳突修补手术。结果其中颞骨占位性听神经瘤3例、面神经肿瘤3例、静脉孔区胆固醇肉芽肿1例、原发于颞骨的胆脂瘤4例,肿瘤均完全切除;中耳胆脂瘤2例,乳突根治术后无复发;Mondini畸形合并内听道底骨质缺损导致耳漏2例、颞骨骨折致耳漏5例,术后脑脊液漏消失。重要的神经、血管、位听器官以及颅底和颅脑组织得到保护或重建。结论外科手术是治疗侧颅底疾病的主要方法,术中应注意保护重要的血管、神经、位听器官以及颅底、颅脑组织。

Objective To evaluate the surgical treatment of communicative lateral skull base diseases. Methods The common ground of 2 0 patients was bone defect of lateral skull base with various reasons leading to communication of intracranial and extracranial. 2 0 patients of communicative lateral skull base diseases were treated with various operations according their lesions and the important vascular, cranial nerve, audio-organ and lateral skull-base- brain tissue were protected or reconstructed. Six patients with tumor of internal audio-canal （ IAC ） t accepted translabyrhithine approach, one patient with lesion of jugular foramen accepted the operation of drainage to the mastoid cavity. Four patients with tumor of temporal bone accepted operation to remove the lesion. Two patients of otitis media with brain abscess were firstly treated by neurosurgeon, then accepted enlarged mastoidectomy. Two patients with cerebrospinal fluid otorrhea of Mondini dysplasia were treated by translabyrhithine approach. Five patients with cerebrospinal fluid otorrhea of temporal bone fracture, accepted repair operation of cerebrospinal fluid otorrhea. Results Three patients with tumor of IAC were neuroma, three were facial nerve tumor, one was cholesterol granuloma of jugular foramen, four were primary cholesteatoma of temporal, the tumors were removed by operation. There were no recurrence in patients of otitis media with brain abscess after enlarged mastoidectomy, cercbrospinal fluid otorrhea disappeared after operation. The important vascular, cranial nerve, audio-organ and lateral skull-base-brain tissue were protected or reconstructed. Conclusion Surgical treatment is the main method of communicative lateral skull base diseases. The important vascular, cranial nerve, audioorgan and lateral skull-basebrain tissue should be protected or reconstructed.