岩斜区肿瘤外科治疗策略探讨

The Strategy of Surgical Treatment on the Petroclival Tumors

目的探讨岩斜区肿瘤的外科处理策略。方法回顾性分析经3种手术方式(岩骨乙状窦前入路、颞下经小脑幕入路、乙状窦后入路)配合神经内镜及电生理监测切除岩斜区肿瘤49例,观察其手术效果及术后并发症。结果岩骨乙状窦前入路11例,肿瘤全切8例,出现新的神经损伤4例,术后改善3例,症状同术前4例;颞下经小脑幕入路18例,肿瘤全切12例,出现新的神经损伤4例,原有神经损伤加重2例,术后改善5例,同术前7例;乙状窦后入路20例,肿瘤全切18例,原有神经损伤加重5例,术后改善8例,症状同术前7例;均无死亡病例。结论岩骨乙状窦前入路、颞下经小脑幕入路、乙状窦后入路是处理所有岩斜区肿瘤的3种首选的基本入路,扎实的显微解剖基本功、娴熟的显微手术技术配合使用神经内镜及术中电生理监测可以提高肿瘤的全切除率,减少并发症发生、降低死亡率。

Objective To investigate the strategies of surgical treatment on petroclival tumors. Methods The data of 49 patients with petroclival tumors resected using three different surgical approaches including petrous hone presigmoid approach, temporal transtentorial approach, sigmoid sinus approach aided with neuroendoscopy and electrophysiologieal monitoring were analyzed retrospectively; the effect of surgery and postoperative complications were also recorded. Results There were 11 cases using petrous hone presigmoid approach with complete tumor removal in 8 patients. New neurological damages were observed in four cases, and 3 cases showed improved neurological function after operation, while the symptoms did not improve in the rest 4 cases. Tumors were completely resected in 12 out of 18 cases using temporal transtentorial approach. Within these 18 cases, four got new neurological damages, two showed aggravated neurological damages, 5 had improved neurological function and the rest 7 cases had the same symptom after operation. There were 20 cases using sigmoid sinus approach with complete tumor removal in 18 cases. The original neurological damages of 5 cases aggravated. The neurological function of 8 cases had been improved , while the rest 7 cases had the same symptom after operation. All patients survived after operation. Conclusion There are three preferred basic approaches to manage the petro- clival tumors, which include petrous bone presigmoid approach, temporal transtentorial approach and sigmoid sinus approach. Improving complete tumor resection rate and reducing the incidence of complications or mortality can be achieved by a combination with neuroendoscopy and electrophysiological monitoring.