颞-枕下-经岩骨入路切除岩斜区肿瘤116例报告

目的介绍采用颞-枕下-经岩骨入路切除岩骨斜坡区肿瘤的手术方法。方法分析116例岩斜区肿瘤患者的手术方法,所有病人均采用颞-枕下-经岩骨入路切除肿瘤,其中采用经迷路后-乙状窦前入路110例,经乙状窦入路2例,经迷路-乙状窦前入路2例,经颧弓-经岩骨入路2例。结果肿瘤全切除75例(64.7%),次全切除33例(28.4%),大部切除8例(6.9%)。手术死亡3例,占手术总数2.6%。结论颞-枕下-经岩骨入路适用于病变位于斜坡中线部位,或肿瘤横跨颞骨岩部内侧,侵及中、后颅凹和累及海绵窦、三叉神经切迹(Meckel凹陷)肿瘤的切除,该方法在术中对岩骨斜坡区能够获得良好的暴露。     

岩尖斜坡区脑膜瘤的显微外科治疗

目的：探索岩尖斜坡区脑膜瘤手术入路和手术效果。方法：通过显微外科手术治疗21例岩尖斜坡区脑膜瘤,根据肿瘤的生长方式和MRI的表现分为三种类型：Ⅰ型5例,主要向中颅窝生长(包括海绵窦);Ⅱ型4例,主要向后颅窝生长;Ⅲ型12例,骑跨岩骨分别向中、后颅窝生长。额颞开颅断颧弓颞下入路切除肿瘤5例。颞枕开颅颞下小脑幕入路切除肿瘤4例,乙状窦前入路10例和乙状窦后入路切除肿瘤2例。结果：肿瘤全切除9例,近全切除11例,部分切除1例;无手术死亡。Ⅰ型岩斜坡肿瘤全切除2例,次全切除3例;Ⅱ型岩斜坡肿瘤全切除3例,次全切除1例;Ⅲ型全切除4例,次全切除7例,部分切除1例。结论：Ⅰ、Ⅱ型多数能全切除,术后效果良好;若Ⅰ型岩斜坡脑膜瘤侵犯海绵窦则难以全切除,术后容易并发动眼神经损伤。Ⅲ型岩斜坡脑膜瘤全切除非常困难,乙状窦前入路是Ⅲ型岩斜坡脑膜瘤最佳的的手术入路。     

经岩骨-小脑幕上下联合入路切除岩斜坡区域病变的手术研究

为研究治疗岩斜坡区病变的新手术入路，采用经岩骨小脑幕上下联合入路切除岩斜坡区肿瘤。结果：共治疗１１例，全切除６例，次全切除４例，部分切除１例，无严重合并症及死亡，随诊５～２９月，无明显复发，生活情况好。结果提示：本手术入路具有显露充分，操作距离近，对颞叶、小脑牵拉轻等优点。     

经岩骨—小脑幕上下联合入路切除岩斜坡区域病变的手术研究

为研究治疗岩斜坡区病变的新手术入路，采用经岩骨－小脑幕上下联合入路切除岩斜坡区肿瘤。结果：共治疗１１例，全切除６例，全切除４例，部分切除１例，无严重合并症及死亡，随衣５－２９月，无明显复发，生活情况好。结果提示：本手术入路具有显露充分，操作距离近，对颞叶、小脑牵拉轻等优点。     

岩斜区脑膜瘤的显微外科治疗

目的：探讨显微手术切除岩斜区脑膜瘤的手术方法及术后疗效，总结临床治疗经验。方法：通过回顾分析我科1997年8月～2006年3月经显微切除19例岩斜区脑膜瘤的临床资料，主要采用岩骨乙状窦前入路、颞下经小脑幕入路、乙状窦后入路3种入路。结果：肿瘤全切除12例（63．2％），5例次全切，2例大部分切除，均无严重并发症发生。结论：术前充分准备、选择合适的手术入路和娴熟显微外科技术可以提高岩斜坡区脑膜瘤的切除率，减少并发症的发生，降低病死率。     

改良颞下经岩骨嵴入路切除岩斜区表皮样囊肿10例

目的 探讨岩斜区表皮样囊肿的临床表现、影像学特征及经改良颞下岩骨嵴入路切除此类肿瘤的可行性.方法 回顾性分析10例岩斜区表皮样囊肿患者采用改良经颞下岩骨嵴入路的治疗情况.结果 肿瘤全切除8例,近全切除2例,无手术死亡病例.结论 改良经颞下岩骨嵴入路创伤小、操作简便、暴露充分,可适用于岩斜区表皮样囊肿的手术切除.     

经岩骨-小脑幕上下联合人路切除岩尖-斜坡肿瘤

目的：报道24例岩尖-斜坡肿瘤经岩骨-小脑幕上下联合人路手术切除。方法：分析肿瘤的临床特点、神经放射学资料，详细介绍该人路的手术方法、注意事项等。结果：本组全切除和次全切除20例(83％)，无手术死亡．无严重并发症。结论：此人路适用于岩尖-中上斜坡肿瘤切除术。     

改良经岩骨乙状窦前入路显微外科治疗岩斜区肿瘤

目的探讨岩斜区肿瘤经改良岩骨乙状窦前入路显微外科治疗的手术特征及并发症。方法回顾性分析经显微手术治疗的9例岩斜区肿瘤,对肿瘤临床和影像学特征、手术入路、手术切除技巧及术后常见并发症的处理进行研究。结果肿瘤全切除7例,近全切除1例,大部切除1例。术后一过性失语1例,脑水肿2例,周围性面瘫1例,脑脊液耳漏1例,腰穿引流后好转。无死亡病例。结论改良经岩骨乙状窦前入路可充分暴露岩斜区肿瘤及其周围结构,是岩斜区肿瘤的较佳手术入路。     

岩斜区脑膜瘤显微手术入路的改良及疗效

目的探讨改良经岩骨乙状窦前入路显微手术切除岩斜区脑膜瘤的疗效及手术技巧.方法采用改良经岩骨乙状窦前入路显微外科切除岩斜区脑膜瘤11例并对其临床资料进行回顾性分析.结果肿瘤全切除8例,次全切除1例,大部切除2例.本组无死亡病例,术后昏迷 1 例,新出现暂时性颅神经障碍3例,无脑脊液漏发生.结论改良经岩骨乙状窦前入路简便、安全,可充分显露岩斜区,有利于提高肿瘤切除程度和术后疗效,是岩斜区脑膜瘤手术治疗的较佳入路,但对术者的手术技巧和经验要求较高.     

岩斜区脑膜瘤显微手术入路的改良及疗效

目的探讨改良经岩骨乙状窦前入路显微手术切除岩斜区脑膜瘤的疗效及手术技巧.方法采用改良经岩骨乙状窦前入路显微外科切除岩斜区脑膜瘤11例并对其临床资料进行回顾性分析.结果肿瘤全切除8例,次全切除1例,大部切除2例.本组无死亡病例,术后昏迷 1 例,新出现暂时性颅神经障碍3例,无脑脊液漏发生.结论改良经岩骨乙状窦前入路简便、安全,可充分显露岩斜区,有利于提高肿瘤切除程度和术后疗效,是岩斜区脑膜瘤手术治疗的较佳入路,但对术者的手术技巧和经验要求较高.     

锁孔入路显微手术切除后颅窝肿瘤的疗效分析

目的 探讨锁孔手术入路应用于后颅窝肿瘤手术的疗效及手术技巧。方法 后颅窝肿瘤患者43例,其中CP角肿瘤20例(听神经瘤18例、脑膜瘤、室管膜瘤各1例)、岩斜区脑膜瘤8例、桥脑肿瘤6例(胶质瘤3例、转移癌2例、胶质增生1例)、四脑室肿瘤4例(髓母细胞瘤、室管膜瘤各2例)、小脑半球肿瘤3例(转移癌2例、血管母细胞瘤1例)、天幕缘脑膜瘤、枕大孔．鞍区．CP角胆脂瘤各1例。根据肿瘤解剖位置及其特性,选择颞下、乳突后或枕下正中锁孔入路进行手术切除。结果 43例肿瘤全切除37例(86．0％),次全切除5例(11．6％),大部分切除1例(2．3％)。无与锁孔入路相关并发症出现。18例听神经瘤患者均肿瘤全切除,面神经解剖保留15例(83,3％),其中1例患者手术后第2天因脑干水肿死亡。8例岩斜区脑膜瘤患者,5例肿瘤全切除,2例次全切除,1例大部分切除,其中2例患者术后遗有轻度偏瘫,1例有轻度面瘫。6例桥脑肿瘤患者,3例肿瘤全切除,3例次全切除,术后无神经功能障碍。其他患者肿瘤均全切除,除1例巨大胆脂瘤患者复视在术后无明显好转外,无其他神经功能障碍。结论 锁孔入路进行后颅窝肿瘤手术具有安全、简捷、微创的效果,是神经外科手术发展的一个方向。     

Subtemporal transpetrosal apex approach: study on its use in large and giant petroclival meningiomas

Background  The subtemporal transtentoral approach has been reported for nearly two decades; however it was not well used due to some limitations in dealing with large and giant petroclival meningiomas. The clinical outcome and merit of the modified subtemporal transpetrosal apex approach in large and giant petroclival meningiomas, as well as the choices, the improvements and the therapy strategies of the microsurgical approach in such patients were evaluated in this study.

Methods  Totally 25 cases of large and giant petroclival meningiomas undergone the modified subtemporal transpetrosal apex approach between April 2004 and January 2010 were enrolled in this study. The choice and improvement of the approach, the basis of anatomy and related research, the effect of accessory equipment, the exposure of tumor and the changes of neurofunction pre- and post-operation were all reviewed retrospectively. The operation outcomes and complications in this approach were also compared with those in the transpetrous presigmoid approach done in 14 cases in the same period.

Results  All 25 cases underwent the modified subtemporal transpetrosal apex approach under electrophysiologic monitoring of cranial nerves and brain stem function. Trochlear nerve was partly wrapped in 14 cases, totally wrapped but can be explored in the initial segment of the cerebellum tentorium in 8 cases, totally wrapped and could not be seen until tumor was partly removed in 3 cases. The cerebellum tentorium was cut along the temporal bone from the anterior part of the apex to the mastoid part of superior petrous sinus in 6 cases, from the posterior part of the apex to the mastoid part of superior petrous sinus in 19 cases. Gross tumor resection was accomplished in 17 (68%) patients, subtotal resection in 7 (28%) patients, and partial resection in 1 (4%) patient. The most common postoperative complication was new neurological deficits or aggravations of preexisting deficit (64%). Follow-up ranged from 3 to 69 months. Compared with the transpetrous presigmoid approach done in 14 cases in the same period, the modified subtemporal transpetrosal apex approach showed obvious advantages such as simplicity in manipulating, microinvasiveness, less time-consuming, less complication, higher rate of tumor resection though the rates of gross tumor resection might be of no significant difference.

Conclusions  Modified subtemporal transpetrosal apex approach has obvious advantages compared with the transpetrous presigmoid approach. Some complications need to be solved by practice and modification of the approach as well as the accumulation of the experiences.

     

Keyhole approach surgery for petroclival meningioma

Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results The maximum diameter of tumors ranged from 2 to 7 cm （mean, 4.5 cm）. Gross total resection （GTR） was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection （STR） was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits （Ⅶ, Ⅶ, Ⅲ and lower CN）. One patient died in the postoperative period. Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.     

PARAPETROSAL PRESIGMOID APPROACH FOR PETROCLIVAL TUMORS

Petroclivaltumorsrepresentmoredifficultto radicalresection.Thesetumorsarelocateddeepat skullbase,usuallywithabundantbloodsupplyand broadattachmenttothepetrous,clivus,andtentori um.Sometimesthetumorinvadesintothecavernous sinusandthevitalperforatingarteries,cranial nerves,andthebrainstemareinvolved[1].Inthepastdecade,withtheadventofskullbase surgeryconcept,moreandmoresurgeonsreported successfulcasesofpetroclivaltumorremoved.Over all,therehasbeenadecreaseinpostoperativemor talityandmorbidity.Se…     

侧脑室肿瘤手术切除15例的临床疗效

目的 :探索手术切除侧脑室肿瘤的方法。方法 :15例侧脑室肿瘤分别为室管膜瘤、脑膜瘤、室管膜下瘤、胶样囊肿、胶质细胞瘤、脉络丛乳头状瘤及脑血管畸形 ,其中 7例侧脑室额角肿瘤经额中回皮质入路 ,2例侧脑室体部肿瘤经胼胝体前部入路 ,5例侧脑室三角区肿瘤经顶枕部皮质入路 ,1例侧脑室颞角肿瘤经颞叶皮质入路。结果 :除 1例侧脑室额角胶质细胞瘤次全切除术后行放疗和化疗外 ,其余肿瘤均手术全切 ,所有病人术后随访 6个月至 1年 ,术后恢复良好 ,参加日常工作。结论 :侧脑室肿瘤绝大多数可行全切除且预后良好     

环枕区及颈段椎管哑铃形肿瘤的显微外科治疗

目的 探讨环枕区及颈段椎管哑铃形肿瘤的手术方法。方法 对经改良枕下远外侧入路和颈后中线入路手术治疗的26例环枕区及颈段椎管哑铃形肿瘤病人的临床资料进行回顾性分析。结果 肿瘤一期全切除23例，次全切除3例，无手术死亡。随访1—9年，所有患者均恢复良好，1例脊索瘤次全切除术后2年复发。结论 经改良枕下远外侧入路和颈后中线入路手术是治疗环枕区及颈段椎管哑铃形肿瘤的一种较理想方法，具有术野开阔、肿瘤显露充分、全切率高等优点。     

经颞下-乙状窦前入路切除巨大岩斜脑膜瘤

目的 :岩斜型脑膜瘤的手术切除相当困难 ,本文对经颞下 -乙状窦前入路切除该区肿瘤作一评价。　 方法 :回顾分析我院 1994年 11月～ 1996年 1月经颞下 -乙状窦前入路切除的巨大岩斜型脑膜瘤 5例。　 结果 :5例患者中 ,全切除 3例 ,其中 2例恢复良好 ,1例术后偏瘫和多脑神经麻痹 ;因肿瘤与脑干不能分开而行肿瘤次全切除和部分切除各 1例 ,其中 1例遗留永久性动眼神经麻痹 ,另 1例术后长期昏迷。　 结论 :经颞下 -乙状窦前入路切除该区肿瘤具有以下优点 :1.到达岩斜区最直接、路径最短 ;2 .手术野开阔 ,显露良好 ;3.可多视角操作 ;4 .只需很轻的脑牵拉。肿瘤不能全切除和患者出现严重并发症的主要原因是 ,肿瘤包裹了基底动脉及其分支及侵犯了软脑膜 ,使肿瘤与脑干间失去蛛网膜界面     

27例最大径大于5cm的咽旁间隙肿瘤临床分析

回顾性分析27例最大径5 cm以上的咽旁间隙肿瘤的治疗效果。17例行颈侧径路,4例颈侧腮腺径路,3例颈侧下颌骨径路,3例颈侧颅底径路切除肿瘤,无明显不良并发症发生。巨大咽旁间隙肿瘤采取合适的手术方法,有效处理术中、术后并发症,多能取得较好的临床效果。