Shi Wei, Xu Qi-wu, Che Xiao-ming, Hu Jie, Gu Shi-xin
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Zhonghua Wai Ke Za Zhi. 2006 Jan 15;44(2):126-8.
To discuss the reasonable choice of the surgical approach to petroclvial tumors.
The clinical data of consecutive 53 patients with the petroclival tumors, treated from June 2002 to June 2004, were reviewed to compare the different surgical approaches to pertroclival region.
Subtemporal transtentorial approach were used in 11 patients, suboccipital retrosigmoid approach in 12 patients, (transzygomatic or orbitozygomatic) frontotemporal (pterional) approach in 12 patients, presigmoid sinus approach in 2 patients, subtemporal and retrosigmoid sinus combined approach in 7 patients, subtemporal anterior petrosal extradural approach in 7 patients and extended transfrontal base extradural approach in 2 patients. Of all patients in this group, total tumor removal was achieved in 32 patients, subtotal in 9, largely partial in 12. The new cranial nerve deficit took place in 16 patients postoperatively, two patients died from coma and serious pneumonia.
Using perfect microsurgical technique, conventional surgical approaches on petroclival region such as suboccipital retrosigmoid approach, subtemporal transtentorial approach can be suitable for most petroclival tumor with the help of neuro-navigation and neuro-endoscopy. To the epidural tumor on petroclival region, the epidural approach should be used with less invasion to the brain tissue. And to the giant petroclival tumor, the combined-tentorial approach can provide an excellent access and exposure to the tumor.
探讨岩斜区肿瘤手术入路的合理选择。
回顾性分析2002年6月至2004年6月连续收治的53例岩斜区肿瘤患者的临床资料，比较不同手术入路治疗岩斜区肿瘤的效果。
采用颞下经小脑幕入路11例，枕下乙状窦后入路12例，（经颧或眶颧）额颞（翼点）入路12例，乙状窦前入路2例，颞下和乙状窦后联合入路7例，颞下岩前硬膜外入路7例，扩大经额底硬膜外入路2例。本组患者中，32例肿瘤全切，9例次全切除，12例大部分切除。术后16例出现新的脑神经功能障碍，2例因昏迷和严重肺部感染死亡。
运用完善的显微外科技术，借助神经导航和神经内镜，枕下乙状窦后入路、颞下经小脑幕入路等传统的岩斜区手术入路可适用于大多数岩斜区肿瘤。对于岩斜区硬膜外肿瘤，应采用对脑组织侵袭较小的硬膜外入路。而对于巨大岩斜区肿瘤，联合小脑幕入路可提供良好的手术通道并充分暴露肿瘤。
