Thedinger B A, Glasscock M E, Cueva R A
Boys Town National Research Hospital, Omaha, Nebraska 68131.
Am J Otol. 1992 Sep;13(5):408-15.
Meningiomas of the cerebellopontine angle (CPA) most often arise from the posterior surface of the petrous pyramid and may extend along the dura to involve the tentorium. Petroclival meningiomas often involve Meckel's cavity and the tentorium. It is impossible to completely remove these large lesions with extension to the supratentorial region by conventional surgical approaches to the CPA such as the suboccipital, middle fossa, or translabyrinthine routes. If total tumor resection is not accomplished, recurrence inevitably follows. A transcochlear approach and actual excision of a large portion of the tentorium allows wide exposure to these large CPA and petroclival meningiomas with supratentorial extension. Thirty-three CPA meningiomas were reviewed from 1976 to 1991. Fourteen patients had tumor extension not only into Meckel's cavity but to the supratentorial region. Ten patients had complete tumor removal, whereas subtotal removal was associated with cavernous sinus invasion. The surgical technique is described in detail with accompanying illustrations. Preoperative symptoms, medical imaging scans, results, and complications are discussed.
小脑脑桥角（CPA）脑膜瘤最常起源于岩骨锥体后表面，并可沿硬脑膜延伸累及小脑幕。岩斜脑膜瘤常累及Meckel腔和小脑幕。采用传统的CPA手术入路，如枕下、中颅窝或经迷路入路，无法完全切除这些延伸至幕上区域的大病变。如果不能实现肿瘤全切，复发将不可避免。经耳蜗入路并实际切除大部分小脑幕，可广泛暴露这些延伸至幕上的大CPA和岩斜脑膜瘤。回顾了1976年至1991年间的33例CPA脑膜瘤。14例患者的肿瘤不仅延伸至Meckel腔，还延伸至幕上区域。10例患者实现了肿瘤全切，而次全切除与海绵窦侵犯相关。文中详细描述了手术技术并配有插图。讨论了术前症状、医学影像扫描结果及并发症。
