岩斜区肿瘤手术入路的选择

Selection of surgical approach for petroclival tumor

目的总结岩斜区肿瘤3种不同入路优缺点,探讨选择手术入路应考虑的因素,以及如何选择入路,并对临床效果进行分析。方法回顾性分析2004—2014年手术切除岩斜区肿瘤21例临床资料,手术入路包括：枕下乙状窦后入路、乙状窦前入路和颞下经小脑幕入路3种,从肿瘤性质、生长方式、术后并发症和操作难度等因素进行分析,总结选择手术入路时如何依据这些因素对3种入路进行选择,观察依据这些因素指导手术入路选择的临床效果,分析正确选择手术入路对保护神经功能、提高患者生存质量,提高手术效果的作用。结果本组21例,全切16例,次全切4例,部分切除1例。神经鞘瘤6例,表皮样囊肿3例,脑膜瘤12例。术后1例为乙状窦前入路,术后出现脑脊液耳漏,颅内发生化脓性感染,治疗无效死亡;5例出现患侧滑车神经损伤,有复视;6例周围面神经瘫痪;1例出现颞叶脑内血肿,经过保守治疗后,血肿吸收,正常出院;3例出现运动性失语,经治疗后,渐好转;3例出现手术区皮下积液并有反复低热,给予留置腰大池治疗,无临床症状出院,1~2月随访,体温正常,积液消失。5例肿瘤残留术后进行放射治疗,未有复发。结论手术入路所经过的解剖结构不同,暴露范围分别有侧重点,术前应当综合考虑各种因素,选择最适合患者入路,这样可以最大限度保护周围组织,提高手术成功率。

Objective To summary the advantages and disadvantages of three different surgical approach approaches of petroclival tumor,and explore factors that should be considered before surgery. And based on these factors,we make sure how to select the approach and analyze the clinical effects. Methods We retrospectively analyzed clinical data of 21 cases with petroclival tumor resection during 2004—2014,which included three kinds＇ surgical approach of presigmoid approach,retrosigmoid approach and subtemporal transtentorial approach. According to the analysis of various factors such as the nature of the tumor,growth pattern,postoperative complications and difficulty of the operation and other factors,we summaried how to select surgery approaches based on these factors. Then we observed clinical effects of the chosen surgical approach based on these directive factors,and analyzed the correct choice role of surgical approach for protecting nerve function,improving quality of life in patients and improving surgical effects. Results The group included 21 patients. 16 cases were total removal,4 cases were subtotal removal,and partial removal includes 1case. Schwannoma was six cases,epidermoid cyst was 3 cases,and 12 cases were meningioma. One case of presigmoid approach showed postoperative cerebrospinal otorrhea. Intracranial suppurative infections occurs in this patient who finally died although active treatment. 5cases showed ipsilateral trochlear nerve injury and diplopia. 6 cases showed postoperative facial nerve paralysis. 1 case showed postoperative temporal lobe intracerebral hematoma. After conservative treatment,hematoma was absorbed and the patient discharged. 3 cases showed motor aphasia,and with active treatment,the patient＇s symptom was gradually improved. 3 cases showed repeated subcutaneous fluid under surgical area and fever. With indwelling lumbar,the patient discharged without clinical symptoms. During follow-up observation lasting 1- 2 month,body temperature went back to normal and fluid gradually disappeared. After radiation therapy,5 cases of patients with residual tumor didn＇t show recurrence. Conclusion Anatomical structures were various which different surgical approaches will pass through,the exposed range had different emphasis respectively. Before the operation,we should consider various factors and choose the most suitable surgical approach for patients,so that we can provide maximum protection for the surrounding tissue and increase the success rate of surgery.