岩斜区肿瘤的显微手术治疗

Microsurgery via three kinds of approaches for petroclival tumors

目的探讨岩斜区肿瘤的显微手术治疗方法及其效果。方法自2010年10月至2014年10月收治岩斜区肿瘤23例,分别采用颞下经小脑幕入路（11例）、乙状窦后经小脑幕入路（7例）和幕上幕下（颞下-乙状窦后）联合入路（5例）进行手术切除。结果 23例岩斜区肿瘤中脑膜瘤9例,神经鞘瘤12例,胆脂瘤2例。颞下经小脑幕入路11例中,肿瘤全切9例,次全切2例;乙状窦后经小脑幕入路7例均全切除;幕上幕下联合入路5例中,次全切4例,部分切除1例。23例患者随访6-36个月;术前Karnofsky功能状态评分为（83.0±7.0）分,术后1月为（75.2±9.0）分,术后6个月为（80.0±6.0）分;6例次全切除及1例部分切除患者术后1月行伽玛刀治疗,在随访时间内未见肿瘤复发。结论根据岩斜区肿瘤的不同类型,选择颞下经小脑幕入路、乙状窦后经小脑幕入路和幕上幕下联合入路,可以提供肿瘤全切率,减少并发症,提高手术疗效。

Objective To explore the methods of microsurgery via three kinds of approaches for the petroclival tumors.Methods Of 23 petroclival tumors including 9 meningiomas, 12 neurilemmomas and 2 cholesteatomas, 11 were treated by microsurgery via thesubtemporal transtentorial approach, 7 by microsurgery via the retrosigmoid transtentorial approach and 5 by microsurgery via thecombined supra- and infratentorial approach. Therapeutic effects were evaluated by Karnofsky performance scale（KPS）.ResultsThescores of KPS were（83.04±7.03） points before the operation in 23 patients with petroctival tumors, of whom, 16（69.6%） received the totalresection of the tumors, 6（26.1%） subtotal and 1（4.3%） partial. No patients died. The following-up from 6 to 36 months showed that thescores of KPS were（75.21±8.98） points 1 month after the surgery and（80.00±6.03） points 6 months after the surgery. New damage to thecranial nerve occurred due to the operation in 10 patients.ConclusionsThe subtemporal transtentorial approach, retrosigmoidtranstentorial approach and combined supra- and infratentorial approach are ideal approaches of the microsurgery for the different typesof the petroclival tumors, which can be exposed extensively with minimal injury by the microsurgery via the above-mentioned approaches.