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

Transpetrosal presigmoid approach for removal of giant petroclival tumors

OBJECTIVE: To discuss the operative technique, advantage and postoperative complications in 41 patients with giant petroclival tumors treated with the supra- and infratentorial transpetrousal presigmoid approach. METHODS: Clinical data were obtained from the review of charts and radiographic images of the 41 patients after operation with temporo-occipotal free osseous flap, partial petrosectomy and mastoidectomy were performed around the labyrinth. The semicircular canals, cochlea and tympanic cavity were protected during the operation. After the super petrous was ligated and cut off, the petroclival region in front of the sigmoid sinus was exposed. RESULTS: In the 41 patients 20 had meningiomas, 20 epidermoid cysts, and one schwannoma. Total resection was performed in 34 patients, subtotal resection in 16, and greater partial resection in one. Major postoperative complications included temporal aphasia (10 patients), cerebral edema (6), brain stem infarct (2), IIIth, VIIth, VIth and posterial group cranial nerves palsies (16, 16, 8, 6 respectively), and cerebrospinal fluid leakage (4 cases). CONCLUSIONS: This approach can expose sufficiently the petroclival region. It can also reveal the area of adjacent sella, interpeduncular and formen magnum, and homolateral III-XIIth cranial nerves. The postoperative complications may be related to operative techniues and tumorous characteristics.