岩斜区表皮样囊肿的显微外科治疗

Microneurosurgical treatment of the petrous and clival regions epidermoid cysts

目的:探讨颅底岩骨斜坡区表皮样囊肿显微外科治疗的手术入路、切除技巧及神经保护方法等。 方法:2 1例岩斜区表皮样囊肿患者中 ,11例采用枕下乙状窦后入路 ,7例采用颞枕经小脑幕入路 ,4例采用颞枕枕下乙状窦后幕上下联合入路手术。结果:肿瘤全切 8例 ,肿瘤次全切 13例。术后临床症状及体征完全消失者 8例 ,较术前明显好转者 4例 ,基本同术前者 8例 ,死亡 1例。 结论 :手术入路的选择应取决于肿瘤的起源和累及部位 ;保护神经功能的关键是应用显微技术囊内切除肿瘤后锐性分离包膜 ,在与神经血管粘连紧密处留部分包膜 。

Objective: To report operations on 21 cases of epidermoid cysts centered on the petrous and clival regions. Methods: A total of 21 patients (9 women, 12 men) who presented with the petrous and clival regions epidermoids between 1992 and 2002 were reviewed. Three microsurgical approaches (subtemporo occipital transtentorial approach, retrosigmoid approach and combinative approach) and different operation techniques were adopted. Results: Total resection was achieved in 8, subtotal resection in 13. The symptom was relieved completely in 8, partially in 4, and unchanged in 8. One patient died. Conclusions: Microsurgical approaches should vary according to location and growth pattern of the cysts. To peel off whole capsule of the tumor was not necessary. Aggressive surgical tumor removal may result in cranial nerve palsy and should be avoided.