经颞下-乙状窦前入路切除巨大岩斜坡脑膜瘤

作者采用经颞下-乙状窦前入路切除5例巨大岩斜坡脑膜瘤,全切除3例,2例恢复良好,另1例遗留对侧偏瘫和同侧Ⅲ、Ⅴ、Ⅵ脑神经功能障碍;次全切除的1例遗留持久性动眼神经瘫痪;而部分切除的1例则长期昏迷伴时侧偏瘫.我们体会此入路的优点有:①到达岩斜区较直接,路径较短;②手术野较开阔,显露良好;③可多视角操作;④只需很轻的脑牵拉.肿瘤不能全切除和病人出现严重并发症的主要原因是肿瘤包裹了基底动脉及其分支以及肿瘤破坏了软脑膜使肿瘤与脑干间失去界面,术前的MRI检查有助于了解肿瘤侵犯脑干的程度和动脉包裹的情况.

Subtemporal-presigmoidal approach for resection of giant petrocli-val meningioma

Five patients with giant petroclival meningiomas were operated upon via substempo-ral-presigmoidal approach. Of the 3 cases with total removal, 2 had good recovery; another one had hemiparesis and multiple cranial nerve palsies. Permanent oculomotor nerve palsy was resulted in one case with subtotal removal, and persistent coma and contralateral hemiparesis existed in one case with partial removal. The advantages of subtemporal-presigmoidal approach include; (1) direct approach with a short distance to the tumor; (2)a wider operating field; (3)broad visualization angles between the subtemporal and presigmoidal exploration; (4) minimal brain retraction . The main influential factors on surgical . results were whether present or not of encasement of the basilar artery and its branches and the arachnoidal cleavage plane between the tumor and the brain stem. Preoperative MRI examination is very helpful to evaluate the arterial encasement and the extent of invasion to the brain stem.