蝶岩斜区肿瘤的显微外科治疗

Microsurgical Treatment of Sphenopetroclival Meningiomas

目的 初步总结蝶岩斜区肿瘤手术治疗的经验。方法 回顾性分析9例蝶岩斜区肿瘤的临床表现、影像学特征、手术方法、手术结果。结果 脑膜瘤5例,表皮样囊肿3例,复发性三叉神经鞘瘤1例。肿瘤全切除7例,次全切除2例。术后死于下丘脑功能衰竭1例;术后面瘫3例,尿崩3例,脑脊液漏并颅内感染1例。随访4例,随访时间6个月～4年;其中脑膜瘤3例,复发性三叉神经鞘瘤1例,影像学上未见肿瘤复发,恢复工作能力结论 只要熟悉手术入路,掌握手术技巧,应用显微技术,蝶岩斜区肿瘤的手术治疗仍能取得较好的疗效。

Objective To summarize experience in microsurgical treatment of sphenopetroclival tumors. Method Clinical mani-festations,radiological features, operative procedures,operative outcomes and follow-up results were analyzed retrospectively. Results There were meningiomas in 5 cases, epidermoidal cysts in 3, recurrent trigeminal neuroinoma in one in this series. Tumors were removed through transpetrosal - presigmoidal approach in 6 cases, and through total petrosectomy approach in 3. Total removal were achieved in 7 cases and subtotal removal in 2. One patient died postoperatively from hypothalamic functional failure. Postoperative facial paresis occurred in 3 cases, insipidus diabetes in 3, cerebrospinal fluid leakage combined with intracranial infection in one. Follow-up were obtained in 3 cases of meningiomas and one case of recurrent trigeminal neuroinoma with follow-up periods between 6 months and 4 years. Radiographic evidence revealed no tumor recurrence. All 4 patients restored to their previous strength. Conclusion Excellent microsurgical results of sphenopetroclival tumors could be achieved by experienced surgical approaches and operative techniques.