应用远外侧髁后入路显微手术治疗枕骨大孔腹侧-下斜坡区肿瘤

Microsurgery for tumors in the ventral foramen magnum and lower clival region via far lateral retrocondylar approach

目的探讨远外侧髁后入路在枕骨大孔腹侧-下斜坡区肿瘤显微手术治疗中的临床应用。方法回顾性分析11例枕骨大孔腹侧-下斜坡区肿瘤病人的临床资料,应用远外侧髁后入路手术切除。采用Karnofsky行为表现量表（KPS）评价临床效果。结果肿瘤全切除8例,次全切除2例,大部分切除1例。病理结果：脑膜瘤5例,胆脂瘤3例,神经鞘瘤3例。并发症主要有后组脑神经损伤、脑脊液漏和脑干缺血。随访6～36个月,死亡1例,余10例随访未见复发。术前KPS评分81.8±7.5;术后1个月KPS评分68.2±23.2,较术前明显下降（P=0.044）;随访6个月KPS评分80.0±27.6,较术后1个月明显上升（P=0.005）。结论枕骨大孔腹侧-下斜坡区肿瘤应用远外侧髁后入路,可以充分暴露脑干腹侧肿瘤,减少对脑干的牵拉和损伤。

Objective To investigate the application of far lateral retrocondylar approach in the microsurgery for tumors in the ventral foramen magnum and lower clival region. Methods Clinical data of 11 patients with tumors in the ventral foramen magnum and lower clival region were analyzed retrospectively, who received microsurgery to resect the tumors via far lateral retrocondylar approach.Therapeutic efficacy was evaluated by Karnofsky performance scale（KPS） score. Results Total tumor removal was achieved in 8patients, subtotal in 2 and partial in 1. The pathological diagnosis was meningioma in 5 patients, cholesteatoma in 3 and neurilemmoma in 3. The main complications were lower cranial nerve injury, CSF leakage and ischemia of brain stem. All the patients were followed up for 6 to 36 months, 1 patient died and no recurrence was found in the rest 10 patients. KPS score was 81.8±7.5 before surgery and 68.2±23.2 one month after surgery, which was lower than that before surgery（P = 0.044）. KPS score was 80.0±27.6 six months after surgery,which was higher than that 1 month after surgery（P = 0.005）. Conclusions Far lateral retrocondylar approach is an ideal one for tumors in the ventral foramen magnum and lower clival region because it can extensively expose the tumors in the ventral brain stem and decrease the traction and injury to the brain stem.