Kawase入路切除上斜坡区肿瘤

The Kawase approach to neoplasms in the upper clival region

目的 评价经Kawase入路切除上斜坡区肿瘤的适用性。方法 应用Kawase入路对 2 1例上斜坡区肿瘤患者进行了显微外科手术。结果 2 1例中有 6例脑膜瘤和 8例三叉神经鞘瘤获得全切 ,4例脑膜瘤和 3例三叉神经鞘瘤获得次全切。术后 2例患者出现永久性动眼神经瘫 ,12例出现暂时性颅神经损害。结论 Kawase入路适用于处理上斜坡区肿瘤。该入路具有如下优点 :(1)可直接进入桥前池及其上方 ,无需牵拉小脑 ;(2 )可同时处理中、后颅凹的病变 ,路径较短 ;(3)在切除肿瘤之前即可分离出小脑幕动脉 ,阻断肿瘤部分血运 ;(4)保留听力 ;(5 )

Objective To evaluate the applicability of Kawase approach to the upper clival neoplasms.Methods Twenty one patients with upper clival neoplasms were treated microsurgically via Kawase approach. Results Total removal was achieved in 6 cases of meningiomas and in 8 cases of trigeminal neurinomas; subtotal removal was achieved in 4 cases of meningiomas and 3 cases of trigeminal neurinomas. Two patients developed permanent oculomotor nerve palsy. Twelve patients developed temporary cranial nerve deficit. Conclusions The Kawase approach is suitable for neoplasms in the upper clival region, espescially for those extending into middle fassa. It has the following advantages: (1) direct access to the prepontine cistern and above without retraction of the cerebellum,(2) convenient access to the posterior fossa and middle fossa,(3)the tentorial artery is detachable before tumor resection, (4) hearing preservation, and (5) less Labbe vein complications.