颞下经天幕入路显微切除岩斜区肿瘤的临床分析

Clinical analysis of microsurgical resection of petroclival tumors by subtemporal transtentorial approach

目的探讨颞下经天幕入路显微手术切除岩斜区肿瘤的方法和疗效。方法回顾性分析13例岩斜区肿瘤的病例资料,均采用颞下经天幕入路切除肿瘤,术中实时电生理监测保护脑神经与脑干功能。结果肿瘤全切除9例,次全切除2例,大部分切除2例。术后发生近期记忆障碍1例,肢体轻度偏瘫1例,感觉性失语1例,治疗随访3个月后均痊愈;动眼神经麻痹1例,随访6个月后未愈。随访时间3个月~2年,全部病例未见肿瘤复发,无死亡病例。结论颞下经天幕入路是切除上斜坡肿瘤的较佳入路,该入路创伤小,解剖简单,路径直接且短,对小脑牵拉轻且显露范围广,术后并发症少,可作为此区域肿瘤切除的理想手术入路。

Objective To investigate the techniques and effects of subtemporal transtentorial approach for resection of petroclival tumors. Methods The clinical data of 13 patients with petroclival tumors were analyzed retrospectively. The surgery was performed via the subtemporal transtentorial approach. Intraoperative electrophysiological monitoring protected the brain and brainstem function. Results Total resection was achieved in 9 cases, subtotal excision in 2 and partial excision in 2. Postoperative short-term memory disorder occurred in 1 case, mild limb paralysis in 1 and sensory aphasia in 1. All the patients recovered well 3 months after treatment. However, oculomotor nerve palsy showed no recovery at 6 month follow up. Follow up lasted from 3 months to 2 years, there was no recurrence and death. Conclusions The subtemporal transtentorial approach may be used as an preferred option for resecting the tumors especially upper clival neoplasms for minimal operative trauma, simple anatomy, short path, and better exposure of tumors with minimal cerebellum retraction and a lower complication rate.