经硬膜内颞下岩尖入路显微手术治疗岩斜区肿瘤

摘要

目的 总结经硬膜内颞下岩尖入路切除岩斜区肿瘤的方法及经验.方法 回顾分析10例经硬膜内颞下岩尖入路手术治疗岩斜区肿瘤患者的临床资料及随访结果.结果 本组10例患者的肿瘤均位于中上岩斜区;其中包括脑膜瘤4例、神经鞘瘤6例;肿瘤全切除9例,次全切除1例,无死亡病例.术后症状完全消失6例,部分缓解4例.术后2例三叉神经鞘瘤患者出现暂时性轻度面瘫,2例面部疼痛患者出现面部麻木.所有患者术后均定期随访,随访时间3~24个月,均无肿瘤复发.结论 硬膜内颞下岩尖入路根据个体需要磨除岩骨骨质增加暴露空间,可有效缩短手术时间.术中可通过缓慢释放中颅窝底及环池周围蛛网膜下腔脑脊液增加暴露空间,根据Labbe's静脉位置向前适当调整颞底暴露可降低静脉损伤风险.硬膜内颞下岩尖入路适用于切除中上岩斜区肿瘤.%Objective To summarize the methods and experiences of intradural subtemporal anterior transpetrosal approach for petroclival lesions.Methods The clinical data and follow-up results of 10 cases with petroclival lesions who were treated via intradural anterior transpetrosal approach were retrospectively analyzed.Results In this group,there were 10 cases with middle-upper petroclival tumors including 4 meningiomas and 6 schwannomas,total resection was achieved in 9 patients and subtotal resection in 1 patient.No death occurred in these cases.The preoprative symptoms disappeared in 6 patients and relieved in 4 patients.The transient neurological deficit includes temporary mild facial palsy in 2 cases with trigeminal neurinomas,2 cases with facial pain occurred facial numbness after surgery.All the patients were follow-up in 3 to 24 monthes and no one relapse.Conclusion The intradural approach tailors the extent of anterior petrosectomy individually and shorten operating time compared with the epidural one.During opration,CSF was released slowly from the base of the middle fossa and the ambient cistern to increase surgical space.To adjust the exposure of the temporal lobe base properly can lower the injury risk of temporal veins according to the position of Labbe's veins.The intradural approach is suitable for the exision of the tumors in middle-upper petroclival region.