Browne J D, Fisch U
Department of Otolaryngology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Otolaryngol Clin North Am. 1992 Apr;25(2):331-46.
The transotic approach to the cerebellopontine angle for resection of tumors invading the internal auditory canal provides superior illumination and exposure for optimal preservation of facial nerve function. Separation of facial nerve from tumor is enhanced with an anterior exposure that allows visualization of the intracranial segment of the nerve before tumor removal without significantly increasing total operative time. Facial nerve grafting or hypoglossal-facial anastomosis may be incorporated into the procedure at the time of tumor resection using the transotic approach. When combined with a musculofascial patch secured to the dural defect, the initial subtotal petrosectomy with eustachian tube and middle ear cleft obliteration generally avoids the complication of an immediate or delayed postoperative cerebrospinal fluid leak. The transotic approach is indicated for tumors up to 2.5 cm in size that are not adherent to the brain stem.
经耳入路至桥小脑角切除侵犯内耳道的肿瘤，可提供更好的照明和暴露，以最佳地保留面神经功能。通过前路暴露可增强面神经与肿瘤的分离，这种暴露能在切除肿瘤前显露神经的颅内段，且不会显著增加总手术时间。在采用经耳入路进行肿瘤切除时，可在手术过程中进行面神经移植或舌下神经-面神经吻合术。当与固定于硬脑膜缺损处的肌筋膜补片相结合时，最初的部分岩骨切除术并闭塞咽鼓管和中耳裂，通常可避免术后即刻或延迟性脑脊液漏的并发症。经耳入路适用于大小达2.5 cm且未粘连于脑干的肿瘤。
