耳前颞下经岩骨经小脑幕硬膜下入路切除岩斜区脑膜瘤

目的探讨耳前颞下经岩骨经小脑幕硬膜下入路切除岩斜区脑膜瘤的手术方法及其治疗效果。方法回顾性分析40例岩斜区脑膜瘤病人的临床资料,采用耳前颞下经岩骨经小脑幕硬膜下入路显微外科手术切除肿瘤。结果肿瘤全切除28例（70.0%）,近全切除10例（25.0%）,大部分切除2例（5.0%）。40例病人随访3~15个月,术后6例发生动眼神经麻痹,均在3个月内完全恢复;10例展神经麻痹病人中,完全恢复4例,不同程度恢复4例,未恢复2例;8例轻度面瘫病人中,完全恢复6例,未恢复2例;12例面部麻木加重病人中,术后恢复至术前水平6例,较术前加重6例;偏瘫2例和失语3例,6个月内恢复至术前水平。无脑脊液漏和手术死亡病例。结论耳前颞下经岩骨经小脑幕硬膜下入路能够充分显露并切除肿瘤基底位于中、上斜坡的岩斜区脑膜瘤,术后脑神经功能障碍、肢体偏瘫、脑脊液漏的发生率低。

Preauricular subtemporal transpetrosal transtenorial subdural approach for removal of petroclival meningiomas

Objective To explore the surgical techniques and outcome of microsurgery via preauricular subtemporal transpetrosal transtenorial subdural approach for the resection of petroclival meningioma. Methods Clinical data of 40 patients with petroclival meningioma were analyzed retrospectively, who underwent microsurgery via preauricular subtemporal transpetrosal transtenorial subdural approach. Results The total resection was achieved in 28 patients （70.0%）, subtotal resection in 10 （25.0%） and partial resection in 2 （5.0%）. Forty patients were followed up for 3 to 15 months. The oculomotor palsy occurred in 6 patients, and who recovered completely 3 months later. Abducens palsy occurred in 10 patients including recovered completely in 4, recovered to some degree in 4 and unrecovered in 2. The slight facial palsy occurred in 8 patients, including complete recovery in 6 and nourecovery in 2. The aggravated facial numbness occurred in 12 patients, including worse symptom severity in 6 and recovery to preoperative level, in 6. Hemiparalysis occurred in 2 patients and aphasia in 3, who recovered to preoperative level in 6 months. No CSF rhinorrhea and no death. Conclusions Full exposure and total resection can be reached through preauricular subtemporal transpetrosal transtenorial subdural approach for petroclival meningiomas with upper and middle clivus base locations, and the rates of cranial nerve dysfunction, bemiparalysis and CSF rhinorrhea are low.