联合耳前、后切口经岩骨和天幕入路切除岩斜区肿瘤13例

Resection of Tumors in Petroclival Region through a Combined Retroauricular and Preauricular Transpetrosal-transtentorial Approach in 13 Patients

目的 介绍采用联合耳前、后切口经岩骨和天幕入路切除上斜坡、岩斜区及鞍隔上(视交叉后)肿瘤的手术治疗经验,并就手术入路进行讨论。方法 对我院采用联合入路手术切除岩斜区肿瘤13例进行回顾性分析。结果 本组13例,全切9例,次全切2例,部分切除2例。出院时按Mayberg分类,Ⅰ级7例,Ⅱ级4例,Ⅲ和Ⅳ级各1例。结论 本联合入路的特点:①可避免和减少术后产生脑脊液耳漏等严重并发征;②在切除岩骨,充分显露颞底、乙状窦前硬膜及天幕的同时,有可能保留听力;③本联合入路不仅适用手术切除上斜坡和岩斜区肿瘤,还能应用手术切除鞍隔上(视交叉后)肿瘤。

Objective To introduce the experience in the surgical treatment of the tumors in upper-clivus, petroclival and suprasellar (retrochiasma) region through a combined retroauricular and preauricular transpetrosal-transtentorial approach. Methods The clinical data of 13 patients with tumors in the petroclival regions which were resected through the combined approach, were analyzed retrospectively. Results Of 13 patients with tumors, 9 received total resection of the tumors, 2 subtotal, 2 part. Class I was 7, class Ⅱ 4, class Ⅲ 1 and class Ⅳ 1 according to Mayberg classification when the patients were discharged from the hospital. Conclusions The advantages of this combined approach include ① it is able to prevent and reduce the serious complications, such as cerebrospinal fluid leakage and the risk of meningitis;② it is hopeful to restore or retain hearing after the petrosal bone is removed to expose completely the dura mater of temporal base, sigmoid sinus and tentorium; ③ it is applicable not only to removing the tumors in upper-clivus and petroclival regions, but also to removing the suprasellar (retrochiasma) tumors.