改良颞下和额颞断颧弓颞下入路切除海绵窦肿瘤的临床对比研究

Improved subtemporal approach and frontotemporal-zygomatic arch subtemporal approach in resection of cavernous sinus tumors： a clinical comparative study

目的 比较改良颞下入路和传统额颞断颧弓颞下入路切除海绵窦肿瘤疗效.方法 回顾性分析改良颞下入路即耳前直切口（保留颧弓）颞下入路组（A组）26例,男12例,女14例,脑膜瘤9例,三叉神经鞘瘤17例;传统额颞断颧弓颞下入路组（B组）22例,男9例,女13例,脑膜瘤8例,三叉神经鞘瘤14例,比较两组病例的全切除率、术后海绵窦侧壁脑神经并发症的发生率、开颅时间等,并进行术后定期随访.结果 两组病例的肿瘤全切除比率,A组为73.08％ （19/26）,B组为81.82％（18/22）,术后海绵窦侧壁脑神经并发症的发生率A组为80.77％（21/26）,B组为86.36％（19/22）,差异均无统计学意义（均P＞0.05）.A组开颅时间为（34.85±6.27） min,B组为（60.86±6.60） min,两组比较差异有统计学意义（P＜0.05）.术后远期随访面神经颞支损伤和颞肌萎缩发生率A组较B组显著减少.结论 耳前直切口颞下入路海绵窦暴露充分,保留了颧弓,手术创伤小,并发症少,是切除海绵窦区肿瘤的一种良好选择.

Objective To compare the efficacy of the improved subtemporal approach and traditional frontotemporal-zygomatic arch subtemporal approach in resection of cavernous sinus tumors.Methods The clinical data of two groups of patients were analyzed retrospectively.There were 26 patients in an improved subtemporal approach （that is preauricular straight incision preserving zygomatic arch） group （group A）.There were 14 females and 12 males,and 9 patients had meningioma,and 17 had trigeminal neurinoma.There were 22 patients in a traditional frontotemporal-zygomatic arch subtemporal approach group （group B）.There were 13 females and 9 males,8 patients had meningioma and 14 had trigeminal neurinoma.The incidence of total resection rate,cranial nerve complications of postoperative lateral wall of cavernous sinus in the patients of both groups were compared,and they were followed up regularly after procedure.Results There was no significant difference in the complete resection rate and the incidence of complications of the cranial nerves between the two groups;however,preserving the zygomatic arch subtemporal approach,the time of craniotomy was shortened significantly.The incidences of postoperative temporal branch injury of facial nerve and temporal muscle atrophy were reduced significantly.Conclusions Preauricularstraight incision subtemporal approach can fully expose the cavernous sinus and preserve zygomatic arch.The surgery trauma and complications are less.It is a good choice for the removal of tumors in cavernous sinus areas.