远外侧经髁入路切除下斜坡和枕骨大孔腹侧肿瘤的解剖与临床研究

目的:探索下斜坡和枕骨大孔腹侧肿瘤的手术入路和手术效果.方法:对12例尸体(24侧)远外侧经髁入路进行解剖,并对21例下斜坡和枕骨大孔腹侧肿瘤进行切除.脑膜瘤10例,神经鞘瘤8例,脊索瘤3例.肿瘤大小:2.0～3.0 cm 6例,3.1～4.0 cm 10例,4.1～5.0 cm 4例,＞5.0 cm 1例.手术入路包括:远外侧经髁后入路16例,部分经髁入路5例.结果:21例肿瘤全切除14例,近全切除6例,部分切除1例,无手术死亡.结论:远外侧经髁入路包括3种情况:经髁后入路,部分经髁入路和完全经髁入路.经髁后和部分经髁入路足够暴露和切除下斜坡和枕骨大孔区肿瘤.

Microsurgical anatomy and clinical study of the far-lateral transcondylar approach to remove tumors situated at lower clivus and ventral to foramen magnum

Objective:To investigate the microsurgical approach and clinical outcome in cases of tumors involving lower clivus and ventral foramen magnum,for rise the total removal rate,lower operative mortality and morbidity,improve operative results.Methods:12 cadaveric heads (24 sides) were dissected through far-lateral transcondylar approach to obtain the anatomical data of this approach. And a retrospective analysis of microsurgical treatment in 21 cases of tumors situated at lower clivus and foramen magnum was performed. Among them,there are 11 males and 10 females,10 patients were pathologically meningiomas,8 patients neuromas,3 patients chordomas. According to the tumor size,the diameter is between 2 to 3 cm in 6 cases,between 3 to 4 in 10 cases,between 4 to 5 in 4 cases,larger than 5 cm in 1 case. Surgical approaches to tumors in this series included far-lateral retrocondylar approach (16 cases),and far-lateral partial transcondylar approach (5 cases).Results:Total removal of the tumor was achieved in 14 patients,subtotal removal in 6 patients,partial removal in one,and without any surgical morbidity.Conclusion:The far-lateral transcondylar approach can be breakdown into 3 variations:retrocondylar,partial transcondylar,and complete transcondylar. According to our research,to treat the tumor situated at lower clivus or foramen magnum,retrocondylar and partial transcondylar approach is enough.