经颞下-乙状窦前入路切除巨大岩斜脑膜瘤

目的 :岩斜型脑膜瘤的手术切除相当困难 ,本文对经颞下 -乙状窦前入路切除该区肿瘤作一评价。　 方法 :回顾分析我院 1994年 11月～ 1996年 1月经颞下 -乙状窦前入路切除的巨大岩斜型脑膜瘤 5例。　 结果 :5例患者中 ,全切除 3例 ,其中 2例恢复良好 ,1例术后偏瘫和多脑神经麻痹 ;因肿瘤与脑干不能分开而行肿瘤次全切除和部分切除各 1例 ,其中 1例遗留永久性动眼神经麻痹 ,另 1例术后长期昏迷。　 结论 :经颞下 -乙状窦前入路切除该区肿瘤具有以下优点 :1.到达岩斜区最直接、路径最短 ;2 .手术野开阔 ,显露良好 ;3.可多视角操作 ;4 .只需很轻的脑牵拉。肿瘤不能全切除和患者出现严重并发症的主要原因是 ,肿瘤包裹了基底动脉及其分支及侵犯了软脑膜 ,使肿瘤与脑干间失去蛛网膜界面

Subtemporal- presigmoidal approach for giant petroclival meningiomas

Objectives:It is still much difficult to excise the meningiomas located in petroclival region.This paper is intended to make an evaluation of the effect of transsubtem- poral- presigmoidal approach in removing the giant petroclival meningiomas. Methods:5 cases with giant petroclival meningiomas were operated on via subtemporal presigmoidal ap- proach from 1 994.1 1 to 1 996 .1 in our hospital. Results:Of the 3cases with total tumor removal,2 had completely recovery,another one had hemiparesis and multiple cranial nerve palsies.Permanent oculomotor nerve palsy was resulted in a case with subtotal removal and prolonged coma and contralateral hemiparesis ocurred in a case with partial removal. Con- clusions:The advantages of subtemporal- presigmoidal approach include:(1 ) Direct access with a short distance;(2 ) A wide surgical field;(3) Multiple visualized angles between sub- temporal and presigmoidal route;(4) Minimal brain retraction.The main influential factors on surgical results were whether encasement of the basilar artery and its branches and whether the arachnoidal cleavage plane between the tumor and the brain stem were prensent.