改良硬膜下Kawase入路切除岩斜区三叉神经鞘瘤11例效果分析

A modified subdural Kawase approach for removal of petroclival trigeminal neurinomas,analysis of 11 cases

目的探讨改良硬膜下Kawase入路切除岩斜区三叉神经鞘瘤的手术方法及疗效。方法对我科2010年1月至2014年12月收治的11例岩斜区三叉神经鞘瘤患者采用改良硬膜下Kawase入路显微手术切除,分析其临床效果。结果11例肿瘤均全切除,其中Mp型（中颅窝为主）4例和M=P型（中-后颅窝相当）7例,无脑脊液漏及死亡率。术后三叉神经麻痹较术前改善1例,无明显变化6例,加重2例,2例面部疼痛均消失。新发短暂感觉性失语1例,一过性滑车神经麻痹2例。术后随访6~56月,无肿瘤复发。结论改良硬膜下Kawase入路可显露中颅窝-鞍旁与后颅窝-中上斜坡广泛区域,对于Mp型和M=P型岩斜区三叉神经鞘瘤是一有效方法,一期肿瘤全切率高,手术并发症低。术中保护Labbé静脉和防止颞叶牵拉挫伤是重点。

Objective To investigate the surgical techniques and curative effect of a modified subdural Kawase approach for resection of petroclival trigeminal neurinomas. Methods A retrospective analysis was performed in 11 eases with petroclival trigeminal neurinomas who were micro-surgically treated via a modified subdural Kawase approach in our department between Jan. 2009 and Dec. 2014. The clinical effective was observed. Results Whole tumor removal was achieved in all the 11 patients including 4 cases of Mp （tumor mainly in middle fossa）and 7 cases of M = P（ tumor equally distributes into both middle and posterior fossa）with no cerebrospi- nal fluid leakage and operative mortality. There was one case with improvement in trigeminal nerve palsy after operation ,6 cases without significant changes and 2 cases with aggravation but facial pain disappearance. There were one case with temporary sensory aphasia and 2 cases with transient trochlear nerve paralysis. No tumor recurrence was found after follow-up 6 -56 months. Conclusion The modified subdural Kawase approach can extensively exposure the upper and middle clivas compartment of posterior fossa as well as the parasellar region of middle cranial fossa. It is adequate for the M = P type and Mp type of petroclival trigeminal neurinomas. It has a high rate of whole tumor resection at the first stage and relatively low risk of complications. The particular concern is the intraoperative protection of the vein of Labbe and the temporal lobe.