颅-眶-颧入路在颅中窝底肿瘤切除术中的应用

目的探讨颅-眶-颧入路的特点及其切除颅中窝底肿瘤的手术技巧和适应证。方法本入路是将额颞开颅颅骨切除的范围扩大到包括眶上缘眶外侧壁及颧弓，以增加肿瘤的暴露，有利于肿瘤的切除，采用该方法对14例颅中窝底肿瘤进行手术，取得良好效果。其中脑膜瘤4例，神经鞘瘤8例，海绵状血管瘤2例。结果获得肿瘤全切除者13例，次全切除者1例，无手术死亡和严重并发症。结论初步手术结果令人满意，该入路具有以下优点：(1)显露良好，可直视下切除的肿瘤范围广；术野平面低，最大限度地减少脑牵拉；(2)可从不同的方向显露并切除肿瘤，对同时侵袭颅内外、硬膜内外的肿瘤切除较彻底。     

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     

经眶颧入路显微手术切除海绵窦肿瘤

目的探讨经眶颧入路显微切除海绵窦肿瘤的手术方法与临床疗效。方法回顾性研究经眶颧入路显微切除的19例海绵窦肿瘤，对肿瘤病理类型、临床和影像学特征、手术入路、手术切除技巧及术后并发症等进行系统分析。结果在手术显微镜下肿瘤全切除17例，近全切除2例。术后原有脑神经症状38％得到改善，43％同术前，19％加重，出现重的脑神经症状5例。无其它严重并发症及死亡病例。结论经眶颧入路可以较好地显露并全切除海绵窦肿瘤，熟知该入路的巨．微解剖、肿瘤与海绵窦结构的病理解剖关系以及熟练的显微手术技能是全切除肿瘤并有效地保护脑神经的关键。     

岩斜区肿瘤手术入路选择的探讨

目的 探讨岩斜区肿瘤的手术入路选择。对53例岩斜区肿瘤患者的手术治疗进行分析。方法患者采用颞底经天幕入路11例,枕下乙状窦后入路12例;（颧弓或眶颧）翼点入路12例;乙状窦前入路2例;颞底、乙状窦后幕上下联合入路7例;颞下前岩骨硬膜外入路7例;扩大的前颅底硬膜外入路2例。结果32例（61％）患者肿瘤全切除,9例（17％）次全切除,12例（22％）大部切除。术后新发生颅神经功能障碍16例（30％）,死亡2例（4％）。结论枕下乙状窦后入路、颞底经天幕入路等岩斜区手术入路均可以在熟练的显微操作技术及神经导航、神经内镜下进行。主体生长于硬膜外的岩斜肿瘤适合于采用硬膜外入路手术切除。幕上下联合入路对巨大岩斜区肿瘤是理想的手术入路。     

颅底肿瘤的显微外科手术治疗

目的：报道颅底肿瘤显微外科手术治疗的临床疗效。方法：回顾分析显微外科手术治疗颅底肿瘤26例的临床特点总结手术。结果：26例颅底肿瘤中，手术全切除22例，次全切除4例，死亡2例，术后随访到24例，脑神经损害或症状加重3例，其余病例全部好转或冷痊愈，全切除的病例术后3－6个月及1年复查MRI均未见肿瘤复发。结论：眶上入路和眶颅颧入路是前、中颅底肿瘤较理想的手术径路，颅中、后窝肿瘤的手术治疗应把经岩骨乙状突前入路作为主要选择，颅底和硬脑膜重 颅底手术成败的关键。     

内镜下经鼻腔鼻窦入路切除D型三叉神经鞘瘤的临床效果

目的探讨单纯内镜下经鼻腔鼻窦入路切除D型三叉神经鞘瘤的可行性和手术入路。方法回顾性分析2014年12月至2021年8月在山东大学齐鲁医院耳鼻咽喉科接受手术治疗的11例D型三叉神经鞘瘤患者的临床资料。男性7例, 女性4例, 年龄(47.5±13.5)岁(范围:12～64岁)。肿瘤累及翼腭窝、颞下窝、筛窦、蝶窦、海绵窦等结构, 部分突入中颅窝, 大小为1.6 cm×2.0 cm×2.0 cm～5.7 cm×6.0 cm×6.0 cm。全身麻醉下内镜经鼻切除肿瘤, 入路包括翼突入路4例, 泪前隐窝入路4例, 扩大泪前隐窝入路2例, 鼻腔外侧壁入路1例。术后观察肿瘤复发情况和主要临床症状恢复情况。结果所有手术在单纯内镜下经鼻腔鼻窦完成, 10例一期全切除, 1例因肿瘤巨大, 操作空间小, 未能实现全切。1例同时切除同侧腮腺区面神经颧支来源及枕部的神经鞘瘤。2例巨大肿瘤切除后中颅底硬脑膜广泛暴露, 其中1例并发脑脊液漏, 取中鼻甲游离黏膜瓣修补, 1例取自体脂肪进行填塞加固。手术时间[M(IQR)]180(160)min(范围:120～485 min), 无严重手术并发症及死亡。术后随访58(6...     

Derome‘s前颅底入路手术方法探讨

Ｄｅｒｏｍｅ＇ｓ前颅底入路手术方法探讨李榕，黄荣华我院将Ｄｅｒｏｍｅ＇ｓ的颅底入路改为扩大额下硬膜外入路切除颅底肿瘤，颅底硬脑膜动静脉瘘，取得较满意效果，现介绍如下：手术方法，病人仰卧上半身抬高１５°。额部发际内冠状皮肤切口，两边达耳部颧弓上。皮瓣翻...     

显微外科治疗颅眶沟通肿瘤

目的 报道颅眶沟通肿瘤显微外科治疗的手术方法和治疗效果。方法 回顾分析过去5年采用显微外科治疗35例颅眶沟通肿瘤的临床资料。分别采用四种开颅和经颅开眶入路，眶内入路采用三种入路方法进行。结果 临床治疗35例肿瘤，其中手术仝切除18例，次全切除13例，大部分切除4例，无手术死亡及严重并发症。结论 (1)根据肿瘤大小、位置和侵袭范同，采用翼点入路、眶额入路、眶上．翼点入路及额颞眶颧入路四种方法开颅，选用四种入路方法经颅开眶及采用三种入路方法进行眶内肿瘤的切除，可充分暴露并能在直视下广泛切除肿瘤；(2)熟练的解剖知识及手术技巧、恰当的手术入路、成功的手术切除和及时处理术后并发症等是治疗的关键；(3)颅底缺损应给予修补和重建，硬膜的严密修复是避免脑脊液漏及颅内感染的关键问题。     

颅鼻眶恶性沟通瘤显微手术12例

目的 探讨颅鼻眶恶性沟通瘤显微手术的入路选择和切除方法. 方法 自2001年6月-2011年11月,经手术和病理证实的12例同时累及鼻部、颅部和眶部的颅底恶性肿瘤患者,根据肿瘤主体位置及侵袭的范围和方向不同,分别选择经扩大额下入路(7例),眶-翼点入路(4例)和额颞眶颧入路(1例)显微手术切除肿瘤和修复颅底缺损,其中5例联合经鼻内镜、2例经鼻侧切开入路. 结果 肿瘤全切除9例,次全切除3例;早期动眼神经不全麻痹2例,无围手术期死亡及颅内感染、脑脊液漏、新神经功能缺损、脑膜脑膨出等严重并发症发生.随访6个月～7年,平均3.8年,5例恢复正常工作,3例生活自理,死亡4例,其中1例术后6个月死于化疗引发的肝功能衰竭,3例3年内死于颅内和全身多发转移. 结论 颅鼻眶恶性沟通瘤手术切除难度大,根据肿瘤主体位置及侵袭的范围和方向不同,选择不同入路或联合入路显微切除肿瘤和修复颅底缺损,能提高手术疗效和减少术后严重并发症的发生.     

扩大中颅窝硬膜外手术入路的研究与应用

目的　介绍扩大中颅窝硬膜外手术入路。　方法　经扩大中颅窝硬膜外手术入路治疗颅底肿瘤２０ 例。　结果　肿瘤全切除１６ 例，次全切除３ 例，大部切除１ 例，无手术死亡。随访２ 个月～２ 年，未见肿瘤复发。　结论　中颅底硬膜外、海绵窦及中、后颅底哑铃型肿瘤可经扩大中颅底硬膜外入路进行手术     

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.     

The transzygomatic approach: A long-term clinical review

Summary The transzygomatic approach has been utilised to improve access to the skull base, infratemporal fossa and orbit for a number of years. It provides a low anterolateral approach to the skull base, along the floor of the middle fossa. It allows both a transsylvian and subtemporal approach with a reduction in brain retraction and better exposure of adjacent neurovasculature structures. A long term review of 53 patients is presented highlighting outcome at two years post surgery and morbidity of the approach. It is concluded that the technique is versatile and can be used to improve exposure of a variety of anatomical locations. There is minimal long term morbidity attributable to the surgery of access and the majority of patients have had good outcomes.     

Extradural dermoid tumor of the petrous apex. Case report

Dermoid cysts are rare, benign, congenital tumors. Most case series thus far have featured intradural tumors. The authors report on a case of an extradural dermoid tumor of the middle cranial fossa with osseous invasion, successfully removed using a left subtemporal extradural approach. The clinical presentation, histological features, radiological findings, and management of this unique case are described.     

经乙状窦后进路切除跨颅中后窝巨大胆脂瘤

目的：介绍手术切除跨颅中后窝生长巨大胆脂瘤的体会和注意事项。方法：采用乙状窦后进路显微外科方法治疗７例跨颅中后窝巨大胆脂瘤。结果：随访５个月～３年，７例术侧症状均消失，未见肿瘤复发征象。结论：表明乙状窦后进路可一期全部切除跨颅中后窝巨大胆脂瘤。     

Epidermoid tumor originating from the petrous bone: report of two cases

In case 1, the tumor was incidentally found in the right petrous bone, middle cranial fossa and cerebello-pontine angle. T1 weighted MRI demonstrated a low intense mass and T2 weighted imaging demonstrated hyperintensity. Through the subtemporal extradural approach, an epidermoid in the middle cranial fossa was partially removed. Postoperative course was uneventfull but an episode of rhinorrhea occurred 15 months later. Bone-window CT scan disclosed air cells of the petrous bone were exposed to the previous surgical cavity. Using the same approach, an epidermoid was totally removed. With the sealing of the tumor cavity with the vascularized muscle flap, the patient became free from rhinorrhea. Case 2 had complainted of sensory impairment in the left trigeminal nerve distribution, atrophy of the left temporal and masseter muscle, and diplopia. T1 weighted imaging of MRI demonstrated a low-intense mass in the left petrous bone, middle cranial fossa, temporal lobe, and cerebello-pontine angle, and T2 weighted imaging demonstrated hyperintensity. The intradural tumor under the temporal lobe was removed at another hospital. As the diplopia deteriorated 5 years later, the patient was re-introduced to our hospital. At first, the tumor in the cerebello-pontine angle was removed using the left retromastoid lateral suboccipital approach. Later, the tumor in the petrous bone and middle cranial fossa was removed through the left subtemporal extradural approach. With the sealing of the tumor cavity with the vascularized muscle flap, postoperative cerebrospinal fluid leakage was prevented. The epidermoid tumor in the petrous apex is a congenital and rare disease. The obstruction of the petrous air cell and dural defect using the vascularized flap is most important to prevent postoperative cerebrospinal fluid leakage.     

显微手术治疗三叉神经鞘瘤

目的 总结各种类型三叉神经鞘瘤手术入路的优缺点。方法 回顾分析１９８０年４月￣１９９７年６月手术治疗的３４例三叉神经鞘瘤的临床效果。结果 肿瘤完全位于中颅窝的３例,均采用颞下入路切除,肿瘤位于后颅窝的１３例,１０例经枕下入路,２例采用颞下经小脑幕入路,１例经乙状窦前入路切除。另１８例哑铃型肿瘤中１４例采用颞下经小脑幕入路,４例采用经颞下－乙状窦前入路切除。结论 颞下入路适用中颅窝型肿瘤切除,枕下入     

Endoscopic versus Open Approach to the Infratemporal Fossa: A Cadaver Study

Introduction Various lateral and anterior approaches to access the infratemporal fossa (ITF) have been described. We provide our observations regarding the endoscopic transpterygoid and preauricular subtemporal approaches, listing their respective advantages and limitations through cadaveric dissection. Methods A cadaver study was performed on five adult specimens. An endoscopic transpterygoid approach to the ITF was completed bilaterally in three specimens, and an open preauricular ITF approach was performed bilaterally in two specimens. Results After completing the cadaveric dissections, we studied differences between the endoscopic transpterygoid approach and open preauricular subtemporal approaches in regard to exposure and ease of dissection of different structures in the ITF. Conclusions In comparison with a lateral approach, the endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure of median structures such as the nasopharynx, eustachian tube, sella, and clivus. We concluded that the endoscopic transpterygoid approach can be utilized to resect benign lesions and some select group of malignancies involving the infratemporal and middle cranial fossae. Open approaches continue to play an important role, especially in the resection of extensive malignant tumors extending to these regions.     

Transzygomatic approach to the tentorial incisura: surgical anatomy

A simple transzygomatic approach to the middle fossa centered on the inferior retraction of the temporal muscle after transection of the zygomatic arch is described. This approach allows a very low basal exposure of the middle and temporal fossa, minimizing the amount of temporal lobe retraction needed to approach intradural and extradural lesion in this location. This approach is simple, easily performed, does not require extensive skull base removal, and still offers excellent visualization of the middle fossa and of the region of the tentorial incisura.     

Transzygomatic Approach to the Tentorial Incisura: Surgical Anatomy

A simple transzygomatic approach to the middle fossa centered on the inferior retraction of the temporal muscle after transection of the zygomatic arch is described. This approach allows a very low basal exposure of the middle and temporal fossa, minimizing the amount of temporal lobe retraction needed to approach intradural and extradural lesion in this location. This approach is simple, easily performed, does not require extensive skull base removal, and still offers excellent visualization of the middle fossa and of the region of the tentorial incisura.     

乙状窦后锁孔入路对颅中后窝区的显微解剖

目的 研究乙状窦后锁孔入路对颅中后窝岩斜区结构的显微解剖,为临床应用该入路解决颅中后窝岩斜区病变提供解剖学依据. 方法 应用福尔马林固定的成人湿性头颅标本10例20侧,模拟乙状窦后锁孔入路对颅中后窝岩斜区进行显微解剖观察. 结果 乙状窦后锁孔入路从后外侧到达颅中后窝岩斜区,可以清楚暴露小脑半球外侧面、颞骨岩部、三叉神经、面听神经、部分后组脑神经、脑桥外侧面、椎动脉、小脑前下动脉.磨除部分岩骨可以扩大内听道及三叉神经的暴露,切开小脑幕缘可以暴露部分滑车神经及部分颅中后窝. 结论 乙状窦后经内听道上锁孔入路充分利用了有效的骨窗,手术创伤小、并发症少.该入路使少数原本需要采用复杂入路方能切除的颅中后窝肿瘤,可通过较简单的手术入路进行切除.对于主体位于颅后窝的岩斜区中小型肿瘤显微切除是一种有效、安全、便捷的微创手术方法.