颞下小脑幕入路切除中上岩斜区肿瘤

Subtemporal transtentorial approach for excision of tumors in mid-superior petroclival region

目的探讨经颞下．小脑幕入路显微手术切除中上岩斜区肿瘤的方法和疗效。方法自2005年1月至2011年12月经颞下-小脑幕入路显微手术治疗中上岩斜区肿瘤患者32例，回顾性分析患者的临床资料和手术方法。结果32例患者术后病理证实脑膜瘤20例，神经鞘瘤7例，表皮样囊肿5例。肿瘤全切除22例，次全切除6例，大部切除4例。15例患者术后出现新的神经功能障碍：肢体偏瘫5例，失语3例，动眼神经麻痹3例，滑车神经麻痹2例，三叉神经麻痹7例，外展神经麻痹4例，面神经麻痹2例，听神经麻痹3例。术后随访3-12个月，神经功能均得到不同程度恢复。结论经颞下一小脑幕入路是切除中上岩斜区肿瘤值得推荐的入路，具有操作简单、创伤小、并发症少等优点。但术前应仔细研究影像学资料，准确判断病变的位置来决定是否采用此手术入路。

Objective To improve the therapeutic effect of the petroclival tumors removed via subtemporal transtentorial approach by mierosurgical techniques. Methods Thirty-two patients with tumors in mid-superior petroclival region, admitted to our hospital from January 2005 to December 2011 and underwent microsurgery through subtemporal transtentorial approach. The clinical manifestations, surgical methods and treatment efficacy were retrospectively analyzed. Results Thirty-two patients with tumors included 20 meningiomas ,7 neurilemmoma and 5 epidermoid cyst. Total resection was achieved in 22 cases, subtotal resection in 6 cases, and partial resection in 4 cases. Fifteen patients developed new postoperative neurological deficits. The patients were followed up for 3 to 12 months, and the neurological functions recovered in varying degrees. Conclusions The subtemporal transtentorial approach is one of the optimal approaches to remove the mid-superior petroelival tumors because of its mini-invasion and less complications, indicatinz for a wide aoolieation in clinic.