采用中颅窝底硬膜外入路显微手术切除三叉神经鞘瘤

目的探讨中颅窝底硬膜外入路显微手术治疗三叉神经鞘瘤的方法和疗效。方法回顾性分析采用中颅窝底硬膜外入路显微手术治疗的27例三叉神经鞘瘤病人的疗效。结果27例病人中肿瘤全切除25例,次全切除2例。术后颅神经功能障碍较术前改善18例,无明显变化4例,加重5例,出现新的颅神经麻痹4例（不完全性麻痹）;2例出现脑脊液漏和颅内感染,经腰穿置管脑脊液引流和抗生素治疗痊愈。本组无术后死亡病例,术后随访6—48个月,除1例于手术后40个月复发并行二次手术治疗外,其余病人均恢复良好。结论该入路对脑组织牵拉轻,术野显露好,可进行多角度操作,有助于提高肿瘤的全切率、降低病残率。

Microsurgical treatment of trigeminal neurinomas with middle fossa extradural approach

Objective To investigate the effect of microsurgical treatment of trigeminal neurinomas with middle fossa extradural approach. Methods Between January 1996 and December 2005, 27 patients with trigeminal schwannomas were treated by middle fossa extradural approach. The clinical data were retrospectively analyzed. Results Total resection was achieved in 25 patients and subtotal resection in the other2 patients. The cranial nerve deficits were improved in 18 patients, unchanged in 4 patients and worsened in 5 patients postoperatively. New Incomplete paralysis of cranial nerve were observed in 4 patients. Cerebrospinal fluid leakages and bacterial meningitis occurred in 2 cases, which were cured by lumber draining and antibiotic therapy. There was not operative mortality. Twenty six patients were followed up for 6 -48 months. Tumor recurrence was found in 1 case after 40 months and was excised again. Conclusion This approach can provide better exposure of these tumors and multiple working angles with minimal brain retraction and can improve the surgical results in terms of increased complete tumor resection rate and reduced complications rate.