乙状窦前入路切除岩斜区肿瘤

Presigmoid approach for removal of petroclival tumors

目的回顾分析15例经乙状窦前入路显微手术切除岩斜区肿瘤病例,探讨乙状窦前入路的临床应用价值。方法 15例患者中男8例,女7例。临床表现:耳鸣、耳聋2例,面部麻木10例,头痛13例,肢体乏力、行走不稳12例;外展神经麻痹5例,后组颅神经麻痹3例,肢体轻瘫6例,共济运动障碍8例。术前行CT检查及MRI检查。肿瘤最大直径为3.0～6.0 cm。所有患者均在全麻下行乙状窦前入路肿瘤切除。手术后病理证实:脑膜瘤8例,胆脂瘤2例,三叉神经鞘瘤2例,大型听神经瘤1例,软骨肉瘤1例,脑转移瘤1例。结果脑膜瘤8例中SimpsonⅡ级切除5例,SimpsonⅢ～Ⅳ级切除3例;胆脂瘤2例全切除;三叉神经鞘瘤全切除1例,大部分切除1例;听神经瘤1全切除;软骨肉瘤1例行大部切除;脑转移瘤1例全切除。术后感觉性失语:1例胆脂瘤患者术后出现,1个月内恢复。第Ⅲ颅神经麻痹1例,第Ⅴ颅神经功能障碍2例,周围性面瘫1例,后组颅神经麻痹1例。结论乙状窦前入路可以近距离暴露肿瘤,是切除岩斜区肿瘤的理想入路。

Objective To analyze the clinical application of presigmoid approach in the removal of petro-clival tumors. Methods There were 8 males and 7 females in flais group, who aged from 25 to 62 years old with a mean of 48 years. The clinical manifestation included tinnitus and deafness in 2 cases, facial numbness in 10 cases, headache in 13 eases, hypodynamia and unsteady gait in 12 cases; VI nerve paralyse in 3 cases, mild limb paralyse in 6 cases, and coordination disturbance in 8 cases. Pre-operative CT and Mill detected that the tumor diameter was 3.0 cm to 6.0 cm. General anesthesia was performed in all patients. Pathological examination confirmed 8 cases of meningiorms, 2 cases of cholesteatomas, 2 cases of trigeminal neurinorms, 1 case of large vestibular neurinon~, 1 case of ehondrosarcoma and 1 case of metastatic tumor. Results Simpson II removal achieved in 5 eases and Simpson ]]I- IV in 3 cases of meningiomas patients. Two cholesteatomas were totally removed; 1 trigeminal neurinoma was totally removed and 1 sub-totally removed. One large vestibular neurinoma was totally removed. Partial removal was achieved in 1 case of chondrosarcoma; and total removal in 1 metastatic tufter. Anepia occurred in 1 patient with cholesteatomas, and recovered within 1 month. Cranial nerve Ⅲ palsy was founded in 1 case, cranial nerve palsy V in 2 cases, facial palsy in 1 case, and cranial nerve IX, X, XI injury in 1 case. Conclusion Presigmoid approach is an ideal surgical approach for petro-clival tumors.