枕下-颞下联合入路颞骨良性肿瘤切除术-附3例报告

目的：介绍枕下一颞下联合入路切除颞骨良性肿瘤的方法及体会。方法：对3例颞枕骨化纤维瘤、颞骨纤维异常增殖症、颞骨血管瘤的巨大颞骨良性肿瘤，均采用枕下一颞下联合入路(倒钩形切口)。辅以显微外科技术进行手术摘除肿瘤。结果：3例均基本完整切除肿瘤，无颅内外感染、脑脊液漏、迷路及颅神经损伤等并发症，经术后随访1．5年～2年未发现肿瘤复发。结论：采用枕下一颞下联合入路切除颞枕骨良性肿瘤可获理想的暴露，最大范围切除肿瘤，可避免损伤毗邻的颅神经、血管以及内耳结构，值得推广。     

乳突-枕下和颞盂入路切除颈静脉孔向颅内外扩展的肿瘤

现代显微外科、影像诊断、介入疗法、影像导航等高新技术的发展 ,使安全、彻底切除颈静脉孔的病变成为可能。切除此处病变的入路有多种〔1～ 6〕,可因病制宜 ,择优选择。若肿瘤在 3cm以上 ,并向颅内或颅外深入扩展 ,企图单纯从一种入路安全地完整切除则有困难 ,本文介绍乳突 -枕下和颞盂入路。此入路的特点是 :可监控颈内动脉 (ICA)远心端及面神经 ,尽量保全听功能 ;充分暴露和彻底切除病变。我们曾从颞盂入路监控面神经和 ICA颅底段 ,切除迷路和岩尖病变 ,收效良好〔7〕。自 1 997年以来 ,我们先后采用经颞盂入路联合乳突 -枕下入路 ,切…     

小脑脑桥角脑膜瘤的显微手术治疗

目的：提高小脑脑桥角（CPA）脑膜瘤的显微手术治疗效果。方法：回顾性分析27例CPA脑膜瘤，根据影像学特征及肿瘤生长方式分为3种类型：Ⅰ型肿瘤基底位于内听道附近者（包括向天幕下生长者）12例；Ⅱ型肿瘤基底在CPA和岩尖向中上斜坡及中颅窝延伸者12例；Ⅲ型肿瘤基底在颈静脉孔附近主要向枕骨大孔延伸者3例。Ⅰ型采用枕下乙状窦后入路；Ⅱ型采用颞枕开颅乙状窦前入路；Ⅲ型采用枕下开颅远外侧入路。结果：按脑膜瘤切除Kabayashi法分级：Ⅰ级4例，Ⅱ级6例，Ⅲ-ⅣA级7例。2例于术后2周内因脑干缺血、水肿或肺部感染死亡。20例随访（平均3.8年），19例恢复良好。2例肿瘤复发，行伽玛刀治疗。结论：Ⅰ型经CPA开颅乙状窦后入路手术切除容易，主要注意保护面神经和听神经；Ⅱ型采用颞枕开颅乙状窦前入路肿瘤全切除可能性大；Ⅲ型采用枕下开颅远外侧入路肿瘤暴露佳，但要注意后组脑神经的保护。     

颅面拆装入路广泛性颅底肿瘤手术(附10例报告)

目的：探讨颅面拆装入路在颅底广泛性肿瘤切除术中的应用。方法：10例范围广泛的颅底区肿瘤分别采用了额鼻拆装,颅面联合入路;上颌窦壁拆装,上颌窦鼻腔入路;颞颧下颌骨拆装,颞面联合入路等3种手术方式切除。结果：2例良性肿瘤术后随访1～3年无复发。8例恶性肿瘤术后,5例已存活3年以上,其中3例已存活5年以上;另3例均在术后3年内死亡或失访,结论：采用颅面拆装入路施行颅底肿瘤切除术,术野暴露较充分,有利于病灶的完全切除,颅底的重要结构可得到保护,并能较好地恢复面部的形态和功能。     

改良颈-腮腺入路高位咽旁间隙肿瘤切除术探讨

目的总结改良颈-腮腺入路切除高位咽旁间隙肿瘤的可靠性和安全性。方法回顾性分析经我科手术治疗的35例高位咽旁间隙肿瘤患者,术前均进行增强CT和MRI评估。其中24例采用单纯的颈-腮腺入路完整切除肿瘤,3例颅底受累者采取颈-腮腺入路联合颞枕侧颅底入路,2例混合瘤患者采用颈-腮腺入路联合下颌角部分切除,3例神经鞘瘤和1例淋巴血管瘤尝试采用颈-腮腺入路联合内镜辅助下手术,1例癌肉瘤和颅底受累及1例颈动脉体瘤术中改行联合下颌骨裂开入路。结果术后病理混合瘤13例,神经鞘瘤11例,副神经节瘤4例,颈动脉体瘤4例,淋巴血管瘤1例,脊索瘤1例和癌肉瘤1例。患者随访11个月～10年,无严重并发症,癌肉瘤患者术后13个月出现脑转移死亡。结论多数高位咽旁间隙良性肿瘤可以经传统颈-腮腺入路完整切除,改良的颈-腮腺入路可以得到清晰的术野暴露,完整切除高位咽旁间隙肿瘤,只有在恶性肿瘤或需要颈内动脉重建时才考虑联合下颌骨裂开术。     

枕骨大孔区脑膜瘤的外科治疗

目的：提高对枕骨大孔区脑膜瘤的认识。方法：回顾性分析我院1993年1月－1999年12月收治的9例枕骨大孔区脑膜瘤,采用枕下正中入路,枕下远外侧入路。结果：肿瘤全切除8例,次全切除1例,无手术死亡,结论：合理选择手术入路能提高肿瘤全切除率和脑神经保护率,枕下远外侧入路是切除枕骨大孔区脑膜瘤的有效手术入路之一。     

不同手术入路治疗前颅底沟通性肿瘤23例

目的 总结前颅底沟通性肿瘤的3种手术切除与修复方法.方法 采用颅面联合径路对16例鼻腔鼻窦颅沟通性肿瘤、鼻-眶-颅沟通性肿瘤切除,并同期行带蒂额肌帽状腱膜裂层颅骨瓣修复;3例眶颅沟通性肿瘤行额下进路手术切除,并行颞肌筋膜修补;4例经翼点入路,颞肌筋膜修补.结果 术后2例发生脑脊液漏,经对症治疗好转,未发生颅内感染.2年生存16例,3年生存7例,5年以上存活4例.结论 颅面联合径路、额下径路、翼点入路进行前颅底沟通性肿瘤切除,加以带蒂额肌帽状腱膜裂层颅骨瓣、颞肌筋膜瓣修复,切除范围安全、彻底,修复方便、可靠,是一种较为理想的手术切除及修复方法.     

侧颅底肿瘤手术入路(附44例报告)

目的:探讨切除侧颅底肿瘤的最佳入路.方法:44例患者中,采用下颌外旋入路17例,耳后C形切口入路16例,上颌外旋入路7例,颞额入路4例.结果:25例良性肿瘤术后无复发;19例恶性肿瘤中,术后生存不足1年2例,1年以上4例,2年以上7例,3年以上6例.结论:下颌外旋入路适用于切除咽旁间隙、颞下窝、鼻咽部、口咽部、蝶骨、斜坡及上颈椎肿瘤;耳后C形切口入路适用于切除颞骨肿瘤.     

颅面拆装入路广泛性颅底肿瘤手术

目的：探讨颅面装装入路在颅底广泛性肿瘤切除术中的应用。方法：１０例范围广泛的颅底区肿瘤分别采用了额鼻拆装，颅同联合入路；上颌窦壁拆装，上颌窦鼻腔入路；颞颧下颌骨拆装，颞面联合入路等３种手术方式切除。结果：２例良性肿瘤术后随访１－３年无复发。８例恶性肿瘤术后，５例已存活３年以上，其中３例已 活５年以上；另３例均在术后３年内死亡或失访，结论：采用颅同拆装入路施行颅底肿瘤切除术，术野暴露较充分，有利于病     

颞盂入路及其在颈静脉球体瘤切除术中的应用

目的介绍颞盂入路切除向颅内外扩展的颈静脉球体瘤。方法采用颞盂入路联合乳突或乳突枕下入路,监控颈内动脉(ICA)和面神经远心端,从颈静脉孔外、后、下3个侧面,于直视下分离切除肿瘤。结果5例颈静脉球体瘤成功切除,术后恢复良好(无下颌运动障碍)。结论颞盂入路联合乳突或乳突枕下入路,可监控ICA远心端和面神经,充分暴露并安全切除颈静脉球体瘤。     

Skull base surgery for removal of temporal bone tumors

CONCLUSION: When selecting the appropriate surgical approach the pathological type of tumor, the physiological status as well as the functional aspects should be considered. Understanding the strengths and weaknesses of each surgical technique and knowledge of the particular tumor biology facilitates selection of the most appropriate surgical approach and a successful outcome. OBJECTIVES: The purpose of this study was to review cases that underwent skull base surgery for a variety of tumors that involved the temporal bone. We reviewed a single center's 25-year experience for epidemiologic characteristics, symptoms, treatment type and outcomes. PATIENTS AND METHODS: The medical records and radiological images of 91 patients, who underwent skull base surgery, were retrospectively reviewed. RESULTS: Among the 91 patients, 61 cases had benign disease and 30 had malignancies. A facial nerve schwannoma was the most common benign intratemporal tumor and a squamous cell carcinoma was the most common malignant tumor. With the facial nerve schwannoma, facial nerve paralysis and hearing loss were the most common presenting complaints; otalgia was the most common presenting symptom for temporal bone cancer. For patients with a glomus tumor, there was a characteristic pulsating tinnitus. A majority of the facial nerve schwannomas were resectable through the transmastoid approach. The infratemporal fossa approach type A was usually required for lower cranial nerve schwannomas and glomus jugulare tumors. However, the fallopian bridge technique with hypotympanectomy was another surgical option. Partial temporal bone resection and subtotal temporal bone resections were performed in cases with temporal bone cancer. The disease free 5-year survival of the temporal bone cancers was 42% and for the squamous cell carcinomas, it was 44%.     

Combined petrosal approaches in the management of temporal bone meningiomas.

OBJECTIVES: To evaluate the indications and outcomes of the combined petrosal approaches in the surgical management of temporal bone meningiomas. STUDY DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: Adults with temporal bone meningiomas. INTERVENTION(S): Meningioma removal using a combined petrosal approach. MAIN OUTCOME MEASURE(S): Cranial nerve outcomes, complications, completeness of resection, and recurrence rates. RESULTS: Forty-nine patients underwent surgical excision of a temporal bone meningioma between 1996 and 2004 at our institution. Nineteen of these patients required a combined petrosal approach for excision. The most common presenting complaints were balance disturbance, 11 (58%); hearing loss, 10 (53%); headache, 10 (53%); and tinnitus, 9 (47%). The most common tumor origin was of the petrous ridge (14; 74%). Average tumor size was 3.1 cm. Complete resection was possible in 17 (89%) patients. Upper cranial nerve (III-VI) function was improved in two (11%) patients and worsened in three (16%) patients. Lower cranial nerve (IX-XII) function improved in one (5%) patient and was worsened in one (5%) patient. Postoperative facial nerve function was Grades I to II in 16 (84%) patients and Grades III to IV in 1 (5%) patient at last follow-up. Hearing data were available in 14 patients. Of those patients, 11 (85%) had serviceable hearing after surgery. The most common surgical complication was a cerebrospinal fluid leak, with three (16%) incidences. There were no reported incidents of stroke, death, or meningitis in the cohort. CONCLUSION: The use of the combined petrosal approach for temporal bone meningioma resection results in favorable outcomes for the patient. The incidence of complications is acceptably low, and cure rates are high.     

Management of malignancy of the temporal bone

An analysis was made of 31 patients with malignancy of the temporal bone treated at Massachusetts Eye and Ear Infirmary between 1959 and 1975. Treatment modalities included: partial temporal bone resection, subtotal temporal bone resection, total temporal bone resection, radical mas-toidectomy followed by radiation therapy, radiation therapy alone, and chemotherapy. When tumor was limited to the external ear canal, partial temporal bone resection was effective in 10 out of 11 patients. When tumor involved the middle ear, subtotal temporal bone resection cured 3 out of 5 patients, and radical mastoidectomy followed by radiation therapy cured 5 out of 12 patients. Total temporal bone resection and chemotherapy failed to cure a patient each, but radiation therapy alone was successful in controlling tumor in one patient.     

颅底骨巨细胞瘤的诊断与治疗

目的探讨颅底骨巨细胞瘤的诊断和治疗原则。方法对2007年8月~2017年4月经病理证实的14例颅底骨巨细胞瘤的治疗经验进行总结。结果14例患者中有8例肿瘤位于颞骨,5例位于蝶骨,1例位于筛骨。手术分别采用内镜经鼻入路、经颞下窝入路、内镜经鼻联合颞下窝入路、经颅中窝入路。其中11例完成肿瘤全切,3例次全切除。手术未出现明显严重并发症。术后患者经过8个月至10年的随访,其中2例患者接受了放疗,所有患者肿瘤均无明显复发或进展。结论发生在颅底的骨巨细胞瘤较罕见,诊断困难,但临床、影像学等仍有其特点,手术是首选的治疗方法,手术入路需个体化制定。     

颞骨和颞下窝联合入路侧颅底肿瘤切除术

探讨安全和彻底摘除广侵侧颅底及其相邻区的肿瘤的手术入路和方法。方法通过颞骨和颞下窝联合入路,应用显微外科技术摘除肿瘤,并尽可能维护或重建颅底和颅神经。     

儿童侧颅底肿瘤的诊断和治疗

目的:探讨儿童侧颅底肿瘤的临床特点、诊断及治疗方法.方法:回顾性分析8例儿童侧颅底肿瘤的临床表现、影像学特点及治疗方法.其中颞部并中、后颅窝巨大三叉神经鞘膜瘤1例.颞部并中、后颅窝黑色素神经外胚层肿瘤1例,婴幼儿颞骨纤维瘤病1例,斜坡脊索瘤1例,鼻咽部胚胎型横纹肌肉瘤2例,神经母细胞瘤2例.1例经颞下窝Fisch C型及迷路上联合径路、1例经岩骨径路、4例经颞下窝Fisch C型径路将肿瘤全切除,1例经腭径路行肿瘤次全切,1例单纯行化疗未做手术.7例手术患儿中4例术前、术后化疗,3例术后化疗.结果:除1例脊索瘤患儿术后5个月复发死亡外,其余7例患儿均存活(6例手术、1例未手术),其中2例鼻咽部胚胎型横纹肌肉瘤术后小灶复发,1例神经母细胞瘤化疗后未行手术的患儿,6个月后复发.除术前1例外展神经、3例三叉神经受累及外,术后2例出现短暂脑脊液漏,1例同侧听力丧失.1例声嘶(同侧声带外展麻痹),2例吞咽困难,术后3～4个月渐恢复.7例手术患儿均无伤口感染裂开及皮瓣坏死,未出现面瘫、脑膜炎及偏瘫、死亡等严重并发症.结论:儿童侧颅底肿瘤生长部位深在、临床症状复杂多样、隐匿、不典型,往往确诊时已为晚期,积极行CT和MRI检查有助于提高早期诊断率.手术切除肿瘤仍为首选,手术前后配合放、化疗.手术径路的选择应依据病变的部位和范围,颞骨和颞下窝联合径路可以最大限度切除侵及该区域的肿瘤,保存脑神经功能,减少并发症.     

眶颅沟通瘤的外科治疗附15例报告

目的：探讨眶颅沟通瘤的外科治疗方法。方法：采用２种手术径路，即：额眶联合径路、经眶径路。结果：１５例眶颅沟通瘤，良性６例，术后随访半年至８年存活；恶性９例，１例术后半年死于肿瘤转移，１例术后３年失访，其余７例随访半年至５年存活。结论：眶颅沟通瘤以外科治疗为主，以上手术径路适用于眶颅沟通瘤的外科治疗。     

颞骨骨化纤维瘤

目的：探讨颞骨骨化纤维瘤的诊断和治疗，提高对该病的认识。方法：报道1例颞骨骨化纤维瘤男性患儿，取耳后沟外切口，暴露瘤体，彻底切除肿瘤组织，封闭外耳道残端，取自体腹壁脂肪填塞术腔；术后定期随诊。结果：术后病理证实为颞骨骨化纤维瘤，术后随访1年无复发，外耳道内端封闭完好。结论：颞骨骨化纤维瘤临床罕见，虽为良性肿瘤，但可压迫和侵袭邻近重要组织和器官，引起功能障碍和颅内感染,一旦确诊，应尽早完整切除。     

Glomus tumors of the temporal bone--surgical concept and results]

Between 1985 and 1991, 36 patients with glomus tumors of the temporal bone were operated. More than 60% of the patients presented with an advanced disease (Class C and D) according to the initially discret and slowly progressive clinical signs. Pulsatile tinnitus, hearing loss and paresis of the lower cranial nerves IV to XII were most often found. The management of the patients requires a complete surgical resection with different approaches depending on the extension of the tumor. High resolution CT of the temporal bone and selective angiography of the tumor feeding vessels proved as reliable and necessary imaging tools to determine the size of the tumor and thereby the surgical procedure. Class A tumors (n = 4) were completely resected by an enaural transmeatal approach. Class B tumors (n = 10) were removed completely in all cases by a combined transmeatal-transmastoid approach. A conductive hearing loss in 2 cases and transient facial paresis in one case were observed. Class C tumors (Glomus jugulare tumors, n = 16) required an infratemporal fossa approach type A. A complete resection was achieved in 87.5%. Class D tumors (n = 6) with intracranial extension were managed in a two stage otoneurosurgical procedure. Due to the tumor size and the required surgical procedure a higher incidence of functional lesions (combined hearing loss, vertigo, cranial nerve pareses) was observed. A facial paresis occurred in all cases but was transient in most of them. The results show that functional conservation surgery for glomus tumors of the temporal bone is only possible in Class A and B and some of the Class C tumors. This requires an early diagnosis.     

Endoscopic treatment of benign tumors of the nose and paranasal sinuses: a report of 33 cases

BACKGROUND: The endoscopic approach can be used successfully for the treatment of benign tumors such as fibroosseous and vascular lesions, pleomorphic adenoma, glioma, meningioma, and schwannoma. METHODS: Thirty-three patients diagnosed with benign tumors of the nasal cavity and paranasal sinuses and treated using an endoscopic approach were reviewed retrospectively. The endoscopic approach was simple in 28 cases and associated with an external approach in 5 cases (because of an intracranial extension of the tumor in four patients and its location at the level of the anterior wall of the frontal sinus in the last case). RESULTS: The resection of the lesions was complete in 32 patients and subtotal in one case. The mean follow-up was 28 months and only two recurrences (6%) were observed in the juvenile angiofibroma group and in the case of the fibrous dysplasia associated to aneurysmal bone cyst, respectively, 20 and 24 months postoperatively. CONCLUSION: In selected cases, endoscopic surgery can be considered an effective treatment for the resection of benign tumors involving the sinonasal tract.