导航辅助下经鼻蝶入路显微切除斜坡脊索瘤

目的 探讨神经导航技术在经鼻蝶入路切除斜坡脊索瘤中的应用.方法 采用经鼻蝶入路显微手术切除斜坡脊索瘤病例10例(均经术后病理证实),所有病例均在术中神经导航辅助下进行,以更好地明确肿瘤与周围重要结构的关系、指导手术.对患者预后进行随访.结果 6例全部切除,4例次全切除,次全切除病例术后行局部放射治疗;平均随访时间12个月,全部切除病例中1例复发,次全切除病例中2例复发.术前有4例外展神经麻痹患者.术后症状缓解2例,另外2例术后随访1年,未见缓解.新发生外展神经麻痹者1例,术后6个月恢复正常,本组无死亡病例.结论 导航辅助下的经鼻蝶入路可以明显提高斜坡脊索瘤的全切率、对周围重要的神经、血管结构起到更好的保护作用,明显降低了术后并发症的发生,是一种较好的治疗斜坡脊索瘤的手术入路.     

经眶额颧弓入路切除颅底肿瘤

目的 探讨经眶额颧弓入路切除颅底肿瘤的优越性和适应证。方法 经眶额颧弓入路切除颅底肿瘤１５例,观察术中显露情况及手术效果,并就该入路优越性和适应证进行分析。结果 １５例中,脑膜瘤７例,全切除６例,次全切除１例;颅咽管瘤４例,全切除３例,次全切除１例;三叉神经鞘瘤２例,生殖细胞瘤１例全切除。术后死亡１例。随访至今１１例恢复良好,３例遗留眼外肌麻痹（仍在恢复中）,无肿瘤复发。结论 经眶额颧弓入路切除颅     

单鼻孔经蝶入路与经颅入路显微切除垂体腺瘤

垂体腺瘤是常见的良性肿瘤,约占颅内肿瘤的10%,近年来有增多趋势。目前主要有经颅手术和经蝶窦手术两大类。本院自2002年6月至2006年6月收治了经颅及单鼻孔蝶窦入路手术切除并病理确诊的垂体腺瘤24例,现报告如下。1资料与方法1.1一般资料:本组病例共24例。其中经单鼻孔蝶     

后外侧枕下入路手术治疗枕大孔前方和下斜坡病变

作者报告一种治疗下脑干和上颈髓腹侧病变的手术入路。它包括枕下瓣状切口形成一侧皮瓣，暴露和切除枕下骨质、颈、半椎板以及酌情切除枕骨髁和颈１外侧块。将椎动脉暴露于术野。采用此手术入路，无手术死亡和与手术入路有关的并发症发生。     

幕上下经岩骨乙状窦前入路切除巨大岩斜部肿瘤

目的 探讨幕上下经岩骨乙状窦前入路切除岩斜部肿瘤手术的技巧及并发症。方法 取颞枕游离骨瓣,分别于迷路前后将乳突及岩骨根部大部切除,但保留骨性半规管、耳蜗及鼓室的完整性;结扎并切断岩上窦,自乙状窦前方抵达岩斜部。结果 ４１例肿瘤包括脑膜瘤２０例,表皮样囊肿２０例,神经鞘瘤１例。手术全切肿瘤３４例,近全切除６例,大部切除１例。术后一过性失语１０例,脑水肿６例。脑干梗塞２例,第Ⅲ、Ⅵ、Ⅶ及后组颅神经损伤     

远外侧枕下入路临床应用的初步经验

目的 改良远外侧枕下入路,适当显露病变,改善延髓和上颈髓腹侧病变的治疗效果。方法 采用远外侧枕下入路的5种改良入路,包括经小关节入路、经枕骨髁后入路、部分经枕骨髁入路、完全经枕骨髁入路和极端外侧经颈静脉孔入路,治疗延髓及上颈髓腹侧和腹外侧肿瘤12例、椎动脉动脉瘤2例,并分析手术治疗的效果和并发症。结果 本组12例肿瘤患者,7例肿瘤全切除,5例肿瘤在部分切除,所有患者术后恢复良好;其中3例术后遗留永久性组颅神经麻痹。2例动脉瘤患者,1例夹闭瘤颈,1例动脉瘤切除的患者因脑干缺血死亡。没有与入路有关的严重并发症。结论 远外侧枕下入路的改良可以满足延髓及上颈髓腹侧和腹外侧病变手术的需要和良好手术野显著,减少不必要的手术步骤,改善治疗效果。     

扩大经蝶入路显微手术切除斜坡脊索瘤

目的 报道应用扩大经蝶入路治疗斜坡脊索瘤的临床效果.方法 采用扩大经蝶入路显微手术切除斜坡脊索瘤病例9例(均经病理结果证实),所有病例均在神经导航下进行,其中经唇下-扩大经蝶入路4例,经鼻-扩大经蝶入路5例.4例术前通过虚拟现实系统实现图像三维重建,明确肿瘤与周围重要结构的关系,以更好的指导手术入路.结果 肿瘤术中显微镜下及术后影像学证实完全切除3例,肿瘤镜下次全切除(切除比例大于90%)6例.其中2例因肿瘤侵犯至硬脑膜下,肿瘤切除后出现脑脊液漏,经颅底重建修补后痊愈.结论 扩大经蝶入路显微手术可以简单迅速地到达斜坡区域,并能较充分地暴露前颅底、中下斜坡以及双侧海绵窦区,术后并发症少,创伤小,对斜坡脊索瘤来讲是一种较好的手术方式.     

经鼻蝶入路窥镜下垂体腺瘤切除的经验

经鼻蝶入路内窥镜下垂体腺瘤切除术是近十年开展的治疗方法，本文就我们的经验总结如下。     

经前后联合入路切除骶骨巨大肿瘤

[目的]探讨骶骨巨大肿瘤的外科治疗。[方法]回顾分析2002年9月~2006年2月经前、后联合入路切除骶骨巨大肿瘤18例。男11例,女7例;年龄31~65岁,平均43岁。恶性肿瘤14例,包括脊索瘤8例,骨巨细胞瘤5例,软骨肉瘤1例,根据Ennek ing分期均属ⅠA~ⅠB;良性肿瘤4例,包括神经纤维瘤3例,动脉瘤样骨囊肿1例。[结果]18例患者无术中死亡,术中无严重并发症,肿瘤均获安全彻底切除,术中出血1000~5000m l。4例术后5~7 d出现皮缘坏死,经换药后2例愈合,另2例经后期臀大肌瓣推移覆盖后愈合,其余切口均一期愈合。术后随访6个月~3.5年,平均2.6年。至目前仅2例脊索瘤术后2年复发。[结论]骶骨巨大肿瘤的骨破坏往往较广泛,盆腔残留间隙狭小,盆腔脏器多有黏连或侵犯,骶骨肿瘤切除术通常有显露困难、出血多、易致大小便功能或性功能障碍和肿瘤不易彻底切除的特点。经前、后入路切除骶骨巨大肿瘤具有骶前显露充分、利于肿瘤完整分离、便于处理血管、利于保护下腹下神经丛等优点。保留单侧S1、S2、S3或双侧S1、S2单侧S3可保全大部分括约肌功能,同时保存大部分下腹下神经丛,可避免性功能障碍。     

内镜辅助经鼻蝶入路至斜坡区的显微解剖研究

目的研究内镜辅助经鼻蝶入路至斜坡区的显微解剖和显露范围，为临床提供解剖学参数。方法测量40例颅骨干标本的骨性结构，10例福尔马林固定的成人尸头标本模拟手术入路，用内镜和显微镜观察斜坡区显露范围，并进行解剖测量。结果前鼻棘至蝶窦口、鞍底、鞍结节中心、鞍背中点、枕骨大孔前端的距离分别为（55．62±4．23）mm、（71．50±6．21）mm、（79．02±4．97）mm、（81．04±8．02）mm、（91．08±5．20）mm；视神经管、颈内动脉隆起、颈动脉管外口、舌下神经管外口离正中线的距离分别为（5．78±1．94）mm、（5．44±2．02）mm、（25．07±2．77）mm、（16．98±1．99）mm；斜坡的长、高分别为（32．43±5．46）mm、（35．01±4．12）mm；上、中、下部的厚度分别为（17．23±3．12）mm、（9．96±3．10）mm、（6．35±2．95）mm。在内镜辅助下，经鼻蝶入路可以通过适当去除相应结构增加显露鞍后．斜坡区的解剖结构。结论内镜辅助经蝶入路可以通过良好的视角显露鞍后．斜坡等显微解剖结构，适用于鞍后．斜坡等颅底中央区病变的手术治疗。     

Giant osteoma of the sphenoid sinus reached by an extradural transbasal approach: case report

Giant osteomas of the paranasal sinuses are infrequent. Those of the sphenoid sinus with neurological symptoms are even rarer. We report here the case of a woman with a giant osteoma of the sphenoid sinus who presented with bitemporal quadrantanopsia and underwent operation via an extradural transbasal approach.     

Proposed classification for the transbasal approach and its modifications.

The transbasal approach offers extradural exposure of the anterior midline skull base transcranially. It can be used to treat a variety of conditions, including trauma, craniofacial deformity, and tumors. This approach has been modified to enhance basal access. This article reviews the principle differences among modifications to the transbasal approach and introduces a new classification scheme. The rationale is to offer a uniform nomenclature to facilitate discussion of these approaches, their indications, and related issues.     

Proliferative potential of human brain tumours as assessed by nucleolar organizer regions (AgNORs) and Ki67-immunoreactivity

Summary Two proliferation markers, silver stained nucleolar organizer regions (AgNOR) and immunoreactivity with Ki-67, were used to assess the proliferative activity in 80 smear preparations from neurosurgically removed intracranial tumours. These included 45 gliomas, 18 meningiomas, 8 metastases and 9 others. We found a remarkably close correlation between the results obtained with both methods. Increasing malignancy, as determined by conventional grading, was paralleled by an increase in the growth fraction and the number of nucleolar organizer regions. Linear regression analysis yielded the following equation: AgNORs/cell=0.35 × L1 (Ki-67) + 3.24, with a correlation coefficient of r_s=0.53 (Spearman rank correlation test, p<0.0001). Thus, both the Ki-67 L1 and the AgNOR technique appear suitable for estimating the proliferative potential in smear preparations of human intracranial neoplasms. The AgNOR technique may be particularly useful for application to stereotaxic biopsies since it can easily be performed on minute tumour samples.Supported by grants from Bundesministerium für Forschung und Technologie and by the Alfred and Ursula Kuleman foundation.     

经上颌骨翻转入路切除颅底侵入瘤

目的 探讨上颌骨翻转入路手术切除颅底侵入瘤的指征、手术要点及优缺点。方法 自1998年11月－2001年8月,采用上颌骨翻转入路连续切除鼻咽颅底肿瘤27例,对临床资料进行回顾性总结。结果 27例中鼻咽癌6例,鼻咽纤维血管瘤5例,鼻咽囊腺癌5例,神经鞘瘤2例,嗅神经母细胞瘤2例,脊索瘤2例,颞下翼腭窝低分化癌2例,颞下翼腭窝肉瘤2例,上颌窦癌1例。18例曾经1次或多次手术切除肿瘤后复发。侵犯颅内重要结构的17例。全部患者术中显露满意,肿瘤均得到肉眼全切除,无手术死亡,术后无偏瘫等严重并发症。本组患者术后随访2－33个月,平均随访16个月。其中2例分别术后5、8个月死于肿瘤复发;2例于术后7、12个月局部复发;1例于术后11个月出现肺转移,现带瘤生存;其余患者恢复日常生活。结论 采用上颌骨翻转入路切除原发于颅底、翼腭窝的肿瘤及广泛侵犯颅底的其他鼻咽部肿瘤,具有显露充分,手术切除彻底的优点。     

The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases.

The combined supra- and infratentorial approach has been subdivided into three variations: the retrolabyrinthine technique (petrous bone resection with preservation of hearing); the translabyrinthine technique (greater petrous bone resection and sacrifice of hearing); and the transcochlear technique (maximum petrous drilling, sacrifice of hearing, and transposition of the facial nerve). These three variations maximize temporal bone drilling and therefore provide exquisite exposure of the clivus and petrous regions with minimal or no brain retraction. The superior petrosal sinus is always sacrificed and the tentorium completely cut. The sigmoid sinus can be transected or kept intact, depending on the venous drainage and the degree of exposure required. A series of 46 patients who underwent the combined approach is presented.     

Posterolateral approach to tumours of the dorsolumbar spine

Summary The authors outline the possible approaches to vertebromedullary tumours of the thoraco-lumbar spine using unilateral or bilateral transverso-arthro-pediculectomy and corporectomy. In a personal series of 20 cases. The technique and indications are described and the results.     

Extended frontal approach with bilateral orbitofrontoethmoidal osteotomies for removal of a giant extracranial schwannoma in the nasopharynx, sphenoid sinus, and parapharyngeal space

BACKGROUND: Although parapharyngeal schwannomas are not uncommon, schwannomas of the nasopharynx and paranasal sinuses are rare lesions. In the absence of intracranial extension, they are usually removed with transantral, lateral rhinotomy or more complex transfacial approaches. CASE DESCRIPTION: We report a 24-year-old patient with a giant benign schwannoma involving the superior parapharyngeal space, pterygopalatine fossa, nasopharynx, and sphenoid sinus with erosion into the clivus that was removed with an extended frontal approach including bilateral orbitofrontoethmoidal osteotomies. CONCLUSION: The advantages of the extended subfrontal over more standard transfacial approaches for lesions in this location include the early dissection of critical neural structures, preserving cosmetics and facilitating management of an inadvertent cerebrospinal fluid leak.