桥小脑角胆脂瘤的显微外科治疗

目的：总结桥小脑角(CPA)胆脂瘤的显微外科手术入路和神经内镜辅助手术。方法：28例桥小脑角胆脂瘤，采用枕下开颅乙状窦后入路16例、颞枕开颅颠下小脑幕入路10例、颞枕开颅幕上下联合入路2例。其中5例手术应用神经内镜辅助。结果：肿瘤全切除21例，近全切除7例，无手术死亡。结论：枕下开颅乙状窦后入路适用于胆脂瘤位于CPA以及由CPA向斜坡生长者；颞枕开颅颞下小脑慕入路适用于CPA胆脂瘤向岩骨尖斜坡及幕上鞍区发展者；巨大胆脂瘤同时累及CPA、鞍区和下斜坡时采用颞枕开颅幕上下联合入路。神经内镜辅助有助于减小手术创伤，提高肿瘤全切率。

Microsurgical treatment of epidermoid cysts at the cerebellopontine angle

Objective:To summarize the microsurgical approach of the epidermoid cyst at the cerebellopontine angle and the endoscopic assisted microneurosurgery.Methods:Twenty eight cases of epidermoid cysts at the cerebellopontine angle were treated with different approaches,including suboccipital retrosigmoidal approach in 16 cases,subtemporal transtentorial approach in 10 cases and 2 cases of combined supra and infra tentorial approach. Five of which were treated with endocopic assisted microneeurosurgery.Results:Total removal of the tumor was achieved in 21 patients, subtotal removal in 7 patients. There was no surgical motality.Conclusion:Suboccipital retrosigmoidal approach is suitable for epidermoid cyst located in CPA and the tumors extend from CPA to clivus region. Subtemopral transtentorial approach is suitable to treat epidermoid cyst invaded sellar and/or clivus region. Combined supra- and infratentorial approach is suitable for huge epidermoid cyst involved CPA, sellar region even extended to infra clivus area. Furthermore, endoscope assisted microneurosurgery can reduce the operation damage and increase the total resection rate of tumors.