改良颞顶部直切口颞下颅中窝底入路切除岩斜区和脑干病变

Modified subtemporal middle fossa approach for the brainstem or petroclival region lesions

目的研究改良颞顶部直切口颞下颅中窝底入路对切除岩斜区和脑干病变的有效性和安全性。方法回顾性分析36例采用颞顶部直切口替代马蹄形切口的颞下入路的病例资料,记录开关颅时间,病变的病理类型和切除程度,术后并发症。结果病变全切除29例,近全切除7例。面神经额支功能保存34例（94.4%）。术后随访9-24个月,颞肌无明显萎缩,外形美观效果良好。1例病人因术后脑内血肿急诊手术清除,恢复良好。无手术死亡。结论在安全和有效性方面,颞顶部直切口可替代传统马蹄形切口进行颞下颅中窝底入路切除脑干和岩斜区病变。这一改良可减少对皮肤、肌肉、血管和神经的损伤。

Objective To study efficacy and safety of modified linear incision in the temporo-parietal region and subtemporal middle cranial fossa approach for removal of the lesion in the brainstem or petroclival regions.Methods The clinical data of 36 patients who received resection of the lesions via subtemporal approach were analyzed retrospectively.The linear incision replaced the horseshoe incision in the craniotomy via subtemporal approach.The time for opening and closing,the tumor resection extent, pathology and location,postoperative complications were recorded.Results Complete lesion resection was achieved in 29 patients and subtotal resection in 7.The function of the frontal branch of the facial nerve was preserved in 34（94.4%） patients.The follow-up from 9 to 24 months revealed good cosmetic results and no obvious temporal muscle atrophy.Only 1 patient required emergent hematoma evacuation,who recovered well.No death occurred.Conclusions With good safety and efficacy,linear skin incision in the temporo-parietal region could replace conventional horseshoe incision in subtemporal middle cranial fossa approach for brainstem and petroclival region lesions.This modification can reduce the trauma to the skin,muscle,vascular and neural structures,thus leading to a good cosmetic result.