小骨窗显微手术切除大型桥小脑角肿瘤及神经功能保护

目的探讨大型（直径≥3cm）桥小脑角肿瘤的小骨窗显微手术切除方法及神经功能保护。方法回顾性分析经乙状窦后入路小骨窗显微手术切除的32例大型桥小脑角肿瘤患者的临床资料,肿瘤全切除28例（87．5％）,次全切除4例（12．5％）。结果本组无手术死亡病例。面神经解剖保留率为93．8％（30／32）,面神经功能（House—BrackmannI、Ⅱ级）保留率为78．1％（25／32）,听神经解剖保留率为87．5％（28／32）,听力保留率68．8％（22／32）。结论采用乙状窦后入路小骨窗显微手术切除大型桥小脑角肿瘤是一种安全、有效的手术方法,在保留神经功能完整性的前提下应尽量切除肿瘤。     

小脑幕脑膜瘤的显微手术治疗

目的 提高小脑幕脑膜瘤的手术治疗效果。方法 回顾性总结42例小脑幕脑膜瘤的临床表现、诊断方式、手术人路的选择与疗效。结果 42例小脑幕脑膜瘤中，位于幕上8例，幕下23例，跨幕上、下11例，侵犯静脉窦17例。肿瘤直径2～5cm有13例，肿瘤直径大于5cm有29例。肿瘤全切除30例，大部分切除8例，部分切除4例。术后恢复：优33例，良7例，差2例，无手术死亡。结论 术前行脑血管造影对判断血供来源和手术处理有重要意义，采用显微外科技术切除肿瘤，能提高全切除率，减少术后并发症。     

神经内镜辅助显微手术治疗脑桥小脑角病变

目的探索神经内镜辅助显微手术治疗脑桥小脑角病变的实用性及其优势。方法对38例脑桥小脑角病变采取乙状窦后入路神经内镜辅助显微手术治疗。结果10例听神经瘤全切并面神经保留，22例胆脂瘤及1例脑膜瘤全切除，5例三义神经痛术后发作性疼痛消失。无术后并发症及死亡。结论经乙状窦后入路神经内镜辅助显微手术治疗脑桥小脑角病变，有利于提高手术疗效，降低手术危险性。     

头偏侧仰卧位在桥小脑角显微手术中的应用

将149例桥小脑角(CPA)区显徽手术病人分为传统组(88例)和改进组(61例).传统组采用俯卧、侧卧或坐位;改进组采用头偏侧仰卧位。观察评估两组病人手术显露租度、CT复查结果、术后并发症发生情况。结果改进组术后并发症明显低于传统组(均P<0.01)。头偏侧仰卧术野显露良好.对脑组织牵拉小(牵拉程度I级25例.Ⅱ级36例),易于医生操作。提示头偏侧仰卧位行CPA肿瘤显微手术切除效果良好。     

三维个体化数字解剖技术在脑桥小脑角肿瘤显微手术中的应用

目的 总结桥小脑角肿瘤21例患者,借助三维个体化数字解剖技术行乙状窦后入路显微手术的临床经验,评价该技术在处理桥小脑角肿瘤的应用价值. 方法 2011年1月至2011年11月共收治桥小脑角肿瘤21例,术前行薄层CTA扫描,数据经3Dview软件重建局部结构,根据解剖标志物设计个体化骨窗范围,术中根据三维个体化解剖模型制作骨瓣及制定显微手术方案行乙状窦后入路显微手术. 结果 所有病例骨瓣均一次成型并复位,无入路相关并发症,术野暴露良好,复位的骨瓣在随访中愈合良好.术后随访3～12个月,均行CT及MRI检查,无1例出现脑脊液漏或皮下积液,无1例出现手术入路相关并发症.术后CT检查均显示骨瓣无移位,并且骨瓣生长良好,三维重建更直观显示颅骨固定及愈合情况. 结论 根据三维个体化解剖技术施行桥小脑角肿瘤的显微手术,能减少术后相关并发症发生.     

显微手术治疗小脑幕切迹脑膜瘤12例分析

小脑幕切迹脑膜瘤指基底位于小脑幕游离缘的脑膜瘤，约占小脑幕脑膜瘤的3％，早期无症状或仅有头痛等非特异性表现．影像学检查肿瘤基底位于小脑幕游离缘和沿游离缘生长的脑膜尾征是其特点。我们白1997年1月至2006年6月收治此类脑膜瘤患者共12例，均行显微手术切除，现报告如下。     

桥小脑角区肿瘤的显微外科手术治疗及预后分析

目的 探讨桥小脑角区肿瘤的显微外科手术治疗方式、方法及预后分析.方法 回顾性分析65例桥小脑角区肿瘤显微外科手术方式、方法及预后.结果 本组肿瘤全切除58例,面神经解剖保留51例,随访1～3 a,面瘫恢复30例,部分恢复8例,无肿瘤复发.结论 娴熟的显微镜下手术技巧及熟熟练掌握相关解剖知识,在切除肿瘤的同时,能最大限度...     

鞍结节脑膜瘤的手术入路选择及显微手术切除

目的 报道鞍结节脑膜瘤手术治疗的入路选择及显微手术的临床效果。方法回顾分析鞍结节脑膜瘤29例的临床资料，29例鞍结节脑膜瘤分别经额下、翼点或额下翼点联合入路，采用显微手术方法切除肿瘤。结果29例均采用显微手术治疗，全切除27例，大部分切除2例，无死亡。28例术后视力得到满意的恢复。结论选择正确的手术入路和采用显微手术治疗鞍结节脑膜瘤，可明显提高临床疗效。     

经翼点入路显微手术切除嗅沟脑膜瘤

目的 介绍一种切除嗅沟脑膜瘤的微创手术方法。方法 采用经翼点入路显微手术切除嗅沟脑膜瘤20例(标准翼点入路6例，翼点锁孔入路14例)，观察肿瘤切除程度和手术效果。结果 全组手术显露良好，肿瘤均全切除(simpson Ⅰ级、Ⅱ级切除)，无额叶脑挫裂伤，仅8例手术输血各400ml，无严重并发症和手术死亡。结论 经翼点入路显微手术是治疗大部分嗅沟脑膜瘤的一种微创方法。     

经枕下乙状窦后入路切除桥小脑角脑膜瘤

目的探讨桥小脑角脑膜瘤的临床特点、手术入路及显微手术技巧。方法回顾性分析我院2010年1月~2013年11月间收治的49例桥小脑角脑膜瘤患者的临床资料。所有患者均经枕下乙状窦后入路运用显微技术切除肿瘤。结果肿瘤达SimpsonⅠ级全切除25例(51.0%),Ⅱ级切除17例(34.7%),次全切除7例(14.3%),无手术死亡。随访47例,随访时间平均2.4年(6个月~4年)。37(78.7%)例正常工作,7(14.9%)例能生活自理,3例(6.4%)生活需他人照顾。随访6个月时面听神经功能保留分别为42例(89.4%)与24例(51.1%)。结论枕下乙状窦后入路是切除桥小脑角脑膜瘤非常适宜的入路,术中结合神经电生理监测并合理运用显微技术,能够理想地切除肿瘤和提高患者生存质量。     

内侧型蝶骨嵴脑膜瘤的显微手术治疗

目的报道应用显微外科手术治疗不同类型的内侧型蝶骨嵴脑膜瘤的临床疗效。方法回顾性分析36例经显微外科手术治疗的内侧型蝶骨嵴脑膜瘤的临床资料。其中21例采用翼点入路，10例采用额下入路，3例采用经额-颞硬膜外入路，1例采用额颞眶颧入路。结果临床治疗36例，其中肿瘤SimpsonⅠ级切除3例（8.3％），SimpsonⅡ级切除22例（61．1％），SimpsonⅢ级切除11例（30．5％）。死亡4例（11．1％）。平均随访36．8个月，随访期间肿瘤复发7例（19．4％）。结论显微手术可提高肿瘤的全切率，术中应妥善处理和保护血管、神经和海绵窦内结构。肿瘤的复发与是否侵袭海绵窦、包裹颈内动脉（ICA）及其分支有关。     

岩静脉在桥脑小脑角肿瘤显微手术中的临床意义

目的探讨岩静脉在桥脑小脑角肿瘤显微手术中的临床意义。方法以2004年12月至2006年3月进行的桥脑小脑角肿瘤显微手术33例为观察对象，其中2例手术中岩静脉撕裂被电凝处理，31例保护良好。结果31例岩静脉保护好的手术后没有发生小脑出血性梗塞，2例电凝处理岩静脉的术后都发生小脑出血性梗塞并水肿，其中1例死亡，1例恢复良好。结论岩静脉在桥脑小脑角显微手术中应尽可能保护良好，若被处理则需在手术后做好再次后颅窝减压手术的准备。     

Tumors of the cerebellopontine angle. Changing policy in treatment

One hundred and twenty-six cases of cerebellopontine-angle tumors with various histologies are presented. Results of 75 operated vestibular neurinomas, 22 meningiomas, and 16 tumors with other histologies are discussed. The method of irradiation and non-radical surgery may be an alternative for treatment.     

Microsurgical excision of the large or giant cerebellopontine angle meningioma.

OBJECTIVE: The object of this study was to analyze the therapeutic effects of microsurgical excision in cases with the large or giant cerebellopontine angle meningioma. METHODS: We retrospectively analyzed the 56 patients who suffered from the large or giant cerebellopontine angle meningioma and underwent the microsurgical therapy, for which the suboccipital-retrosigmoidal approach was adopted in 38 cases, the temporal-occipital craniotomy, presigmoidal approach in 6 cases, the temporal-occipital craniotomy, inferotemporal tentorium cerebelli approach in 8 cases, and the temporal-occipital craniotomy, supratentorial or infratentorial allied approach in 4 cases. RESULTS: The tumors of 44 cases were all resected (Simpson I, II), with a total resection rate of 78.6%, and there was no operative mortality. After surgery, symptoms improved in 40 cases and remained unchanged in 10 cases. Among 54 cases, recrudescence was seen in 2 cases (3.7%) and being able to take care of themselves in 50 cases (92.6%) at 6 months through 6 years follow-up after surgery. CONCLUSION: A rationally selected surgical approach, a microscopic technology applied in the operation to appropriately treat and protect vein, nerve and brain stem, which can ideally excise the tumors, together can increase the survival ability of patients.     

大型听神经瘤的显微手术

目的 报道大型听神经瘤显微手术切除、面神经解剖保留及功能恢复的临床效果.方法 采用枕下乙状窦后入路切除大型听神经瘤82例,并将术后面神经功能HB分级为Ⅲ～Ⅵ级者随机分为2组,分别予Kabato康复训练和常规治疗,对其临床资料进行回顾性总结.结果 肿瘤全部切除77例(93.9%),次全切除5例.面神经解剖保留78例(95.1%),术后训练组面神经功能恢复较快,且显效率和有效率均明显高于非训练组.随访6个月～3年,次全切除5例中复发2例,3例患者出现慢性头痛,无长期昏迷、死亡病例.结论 全切除肿瘤的同时保留面神经功能,是大型听神经瘤显微手术的目标.     

Lipoma in the cerebellopontine angle

A case of lipoma in the cerebellopontine angle is reported. Intracranial lipomas are very rare, especially in the cerebellopontine angle. To our knowledge, only four cases, including our own, have been operated upon. Until now, total extirpation has not been possible. The singular appearance on computed tomography scanning of this dysembryoplasia is presented together with a bibliography of this subject.     

Surgical treatment of cerebellopontine angle meningiomas in elderly patients

Summary Background. The aim of this study is to assess the morbidity and mortality of meningioma surgery in patients over 70 years of age harbouring a tumour at the cerebellopontine angle as one representative location of the posterior fossa in comparison with a matched group of young patients.Method. A retrospective analysis based on clinical charts, surgical records, histological records, imaging studies and follow up records was conducted to select patients over 70 years who underwent surgery for cerebellopontine angle meningiomas. Tumours with comparable size and location were matched with the younger group.Findings. There were 421 meningiomas located in the cerebellopontine angle, 21 patients were older than 70 years (range 70–84). Median Karnofsky-Index at presentation was 80 (50–90), 16 patients had a physical status grading ASA 2 and 5 patients ASA 3. The average length of hospital stay was 22 days (7–99 days). The postoperative median Karnofsky score at time of discharge was 80 (50–90). The most common medical complication was postoperative pneumonia in 4 patients, among them 3 patients had lower cranial nerve disturbances postoperatively. There were 56 younger patients (mean age 52.4 years; range 24.5–69.75 years) with corresponding tumour size and location. Pre-op Karnofsky score was 80 (70–90), 53 patients were graded as ASA 2 and 3 patients as ASA 3. Length of hospital stay was 13.6 days (8–32 days). Post-op Karnofsky score was 80 (50–90). Among 5 patients with postoperative lower cranial nerve disturbances no patient had pneumonia postoperatively. There was no peri-operative mortality in either group.Conclusions. With modern neurosurgical techniques and neuro-anesthesia elderly patients with CPA meningiomas can be operated on with acceptable low morbidity and good neurological outcome but recovery from surgery lasts longer compared to younger patients. However, postoperative lower cranial nerve deficits in elderly patients may not be well tolerated compared with younger patients.