Li Yongtuan, Chen Ying, Xu Shujun, Rong Baogang, Ding Yuanping, Zhang Hanbing
Department of Otolaryngology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004 Apr;18(4):197-9.
To explore the surgical approach to the lesions of the cerebellopontine angle and the petroclival region.
Nine cases of the cerebellopontine angle or petroclival large tumors and one case of the posterior cerebral thrombotic aneurysm were treated by the combined presigmoid supra-infratentorial approach. The tumors including 3 cases of schwannomas and 6 cases of meningiomas spaned supra-infratentorium in our study.
Complete tumor removal were achieved in 6 cases, and subtotal tumor removal in 4 cases. After the operation, Cerebrospinal fluid leakage followed intracranial infection occurred in 1 case which losing follow-up. Headache and dizziness relieved in the other 9 cases. One case improved and 3 cases with no improvement after surgery among the 4 preoperative facial paralysis patients. Three cases with cerebellar symptoms were much relieved, but most deficits involving other cranial nerves preoperation did not recover. According to Samii's prognosis standard, 7 cases with good results and 1 case with common and 1 case with bad had been achieved. The hearing level had no influence in 5 cases, declined 20 dB HL in 2 cases, 30 dB HL in 1 case and 60 dB HL, in I case.
The combined presigmoid supra-infratentorial approach is a direct route to the petroclival region and the cerebellopontine angle, provides a wide surgical field with less cerebellar or brain retraction, facilitates the removal of lesions and preserves the cranial nerves functions.
探讨桥小脑角区及岩斜区病变的手术入路。
采用乙状窦前幕上下联合入路治疗9例桥小脑角区或岩斜区大型肿瘤及1例大脑后交通动脉瘤。本研究中，肿瘤包括3例神经鞘瘤和6例脑膜瘤，跨越幕上下。
6例肿瘤全切，4例次全切除。术后1例出现脑脊液漏继发颅内感染，失访。其余9例头痛、头晕缓解。术前4例面瘫患者中，1例术后改善，3例无改善。3例小脑症状患者明显缓解，但术前累及其他颅神经的多数功能障碍未恢复。根据Samii预后标准，7例效果良好，1例一般，1例差。5例听力水平无影响，2例下降20dB HL，1例下降30dB HL，1例下降60dB HL。
乙状窦前幕上下联合入路是到达岩斜区和桥小脑角区的直接途径，手术视野开阔，对小脑或脑的牵拉较小，便于病变切除并保留颅神经功能。
