前颞下"锁孔"入路显微手术的临床应用

目的以"锁孔"微创的理念,改良常规颞下入路,以减少手术损伤.方法采用耳前方颧弓向上直切口4 cm,铣开2.0～2.5 cm左右直径骨窗,经颞下行海绵窦、脑干、岩斜区部位病灶的手术治疗13例.结果6例岩斜区脑膜瘤全切除4例,次全切1例,大部切除1例;脑干转移癌、颞底胶质瘤各1例均全切除,海绵窦脑膜瘤、脑桥胶质瘤各1例次全切除,脑桥病灶出血1例予AVM切除、血肿清除,海绵窦内血栓1例子全切除,大脑后动脉瘤1例予夹闭.1例术后出现脑脊液耳漏,经原入路修补后痊愈.2例岩斜区脑膜瘤切除术后遗有轻度偏瘫.结论颞下"锁孔"入路可满足岩斜区、脑桥腹、侧方及海绵窦区的手术要求,是一种行之有效的微创手术入路.

Clinical application of anterior subtemporal keyhole approach microsurgery

Objective Based on the rationale of "keyhole" minimally invasive neurosurgery, the normal subtemporal approach was modified to decrease the surgical trauma. Methods A straight skin incision of 4cm was made, just in front of the ear and above the zygomatic arch. Afterwards, a bone window with a diameter of 2.0~2.5cm was opened. 13 operations via the subtemporal keyhole approach were performed to deal with lesions located at cavernous sinus, brain stem and petroclival region. Results Among 6 petroclival meningiomas, 4 were resected totally, 1 subtotally and 1 mostly. One metastasis cancer in the brain stem and one temporal glioma, as well as one thrombus at the cavernous sinus, were removed totally, while one meningioma at the cavernous sinus and one glioma at the pons were subtotally removed. Additionally, one bleeding pontine AVM was removed successfully, together with the hematoma. One aneurysm located at the cerebral posterior artery was clipped successfully. Only one patient suffered from postoperative cerebrospinal fluid otorrhea, which was cured later by successful reparation via the same approach. Two patients presented hemiparesis after petroclival meningiomas resected. Conclusion This subtemporal "keyhole" approach can meet surgical requirements for lesions located at petroclival region, ventral and lateral parts of the pons as well as cavernous sinus. It is an effective and practicable approach for minimally invasive operations.