耳前锁孔颞下入路切除岩斜区肿瘤

目的 探讨电生理监测下耳前锁孔颞下入路显微手术治疗岩斜区肿瘤的手术技巧和治疗效果。方法 根据肿瘤术前影像学特点,采用耳前锁孔颞下入路切除肿瘤,术中辅以神经电生理监测。结果 本组共18例患者,其中15例肿瘤全切除(83.3%),2例次全切除(11.1%),1例大部切除(5.6%)。术后出现动眼神经麻痹1例,术后9 d出院时已恢复;复视2例,其中1例4个月后恢复,1例6个月后复查明显缓解;面部感觉减退3例,1例2个月后基本缓解,2例6个月后恢复;面瘫1例,6个月后痊愈;无脑脊液漏、偏瘫、失语及死亡病例。结论 耳前锁孔颞下入路显微手术是治疗主要位于中、上斜坡的岩斜区肿瘤的理想选择,术中神经电生理监测有助于保护神经功能,减少神经功能损害。

The application of preauricular subtemporal keyhole approach in petroclibal region tumor surgery

Objective To investigate the surgical techniques and clinical efficacy of removing tumors in the petroclibal region through preauricular subtemporal keyhole approach. Methods The microsurgery via preauricular subtemporal keyhole approach was performed based on preoperative imaging characteristics of the tumors. Results In all 18 cases, total removal of the tumors was achieved in 15 (83.3%) and subtotal in 2 (11.1%) cases, and in 1 case the major part of tumor was removed (5.6%). After surgery, oculomotor paralysis occurred in 1 patient, who completely recovered in 9 days; ambiopa was observed in 2 patients, who recovered 4 and 6 months later, respectively; facial hypesthesia was found in 3 patients, 1 of whom returned to normal in 2 months and another 2 recovered 6 months later; facioplegia occurred in 1 patient, who recovered 6 months later. No CSF leakage, hemiplegia, aphasia or death occurred. Conclusion Preauricular subtemporal keyhole is a reasonable approach to remove tumors in the petroclibal region. Intraoperative electrophysiologic monitoring of cranial nerves and brain stem function is useful for the protection of neurological function.