经小脑裂入路手术治疗桥小脑角区肿瘤的临床研究

摘要

Objective To explore the safety and effectiveness of this surgical approach in treating tumorsof cerebellopontine angle ( CPA ) area and opening cerebellar fissure .Methods Clinical data of 39 patients ( acoustic neuromas 31 cases, meningiomas 8 cases ) with large cerebellopontine angle tumors (≥3.0 cm ) who accepted operation treatment via this surgical approach from February 2009 to January 2016 were collected , then retrospective analysis was performed.Results Large acoustic neuromas were totally resected for 15 cases, nearly totally resected for 11 cases,and subtotally resected for 5 cases.Facial nerves were anatomically preserved for 29 cases,not preserved for 2 cases,end-to-end anastomosis of facial nerve was performed for 2 cases.Meningiomas were totally resected for 8 cases.Conclusions This surgical approach can utilize the natural space of cerebellum in limited bone window to realize operation space ,while not pulling or less pulling other tissues .Characterized by small injury , less complications , less pulling injury on brain tissues , nerves and blood vessels , it is same as or superior to the traditional craniotomy in treating tumors especially large tumors ( diameter not less than 3 cm ) in cerebellopontine angle region with less operation incision and bone window scope .%目的：探讨经小脑裂入路手术治疗桥小脑角区肿瘤的安全性和有效性。方法回顾性分析2009年2月～2016年1月经该入路手术治疗的39例大型桥小脑角肿瘤（直径≥3．0 cm）患者的临床资料，其中听神经瘤31例，脑膜瘤8例。结果31例听神经瘤患者中，全切除者15例，近全切除11例，次全切除5例；29例患者面神经解剖保留，2例患者未能解剖保留，均于术中行面神经端端吻合。8例脑膜瘤患者均全切除。结论该入路在有限的骨窗内，利用小脑自然间隙，在不牵拉或少牵拉的情况下，达到了手术操作所需的空间，创伤小，并发症少，降低脑组织、神经、血管的牵拉损伤风险；以较小的手术切口及骨窗范围使桥小脑角区肿瘤特别是大型肿瘤（直径≥3 cm）的手术效果达到或优于传统开颅手术。