乙状窦前小脑幕上下联合径路的临床应用

Clinical application of the combined presigmoid supra-infratentorial approach

目的 :探讨适宜外科治疗桥小脑角区和岩斜区病变的手术途径。方法 :采用乙状窦前小脑幕上下联合径路 ,手术治疗 9例跨越小脑幕上下的桥小脑角、岩尖、岩斜区肿瘤 ,其中神经鞘瘤 3例 ,脑膜瘤 6例 ;1例大脑后动脉血栓性动脉瘤。结果 :病变全切 6例 ,次全切除 4例。术后 1例出现脑脊液漏并发颅内感染并失访。其余9例头痛、头晕症状均明显好转或消失 ;其中 4例术前面瘫患者 ,1例术后稍好转 ,3例无改变 ;3例术前并发小脑症状的患者术后有明显改善 ;术前并发的其他脑神经受累症状术后无好转 ;预后按Samii等标准判定 ,7例恢复好 ,1例预后一般 ,1例预后差。术后听力无改变 5例 ,听力下降 2 0dBHL 2例 ,下降 30dBHL 1例 ,下降 6 0dBHL 1例。结论 :乙状窦前小脑幕上下联合径路术野宽阔、清晰 ,无需过度牵拉脑组织 ,便于切除桥小脑角区、岩斜区占位病变 ,并能较好地保护脑神经功能。

Objective:To explore the surgical approach to the lesions of the cerebellopontine angle and the petroclival region.Method:Nine cases of the cerebellopontine angle or petroclival large tumors and one case of the posterior cerebral thrombotic aneurysm were treated by the combined presigmoid supra-infratentorial approach. The tumors including 3 cases of schwannomas and 6 cases of meningiomas spaned supra-infratentorium in our study.Result:Complete tumor removal were achieved in 6 cases, and subtotal tumor removal in 4 cases. After the operation, Cerebrospinal fliud leakage followed intracranial infection occurred in 1 case which losing follow-up. Headache and dizzeness relieved in the other 9 cases.One case improved and 3 cases with no improvment after surgery among the 4 preoperative facial paralysis patients.Three cases with cerebellar symptoms were much relieved, but most deficits involving other cranial nerves preoperation did not recover.According to Samii's prognosis standard, 7 cases with good results and 1 case with common and 1 case with bad had been achieved.The hearing level had no influence in 5 cases,declined 20 dB HL in 2 cases,30 dB HL in 1 case and 60 dB HL in I case.Conclusion:The combined presigmoid supra-infratentorial approach is a direct route to the petroclival region and the cerebellopontine angle, provides a wide surgical field with less cerebellar or brain retraction, facilitates the removal of lesions and preserves the cranial nerves functions.