Daspit C P, Spetzler R F, Pappas C T
Division of Neurology, Barrow Neurological Institute, Phoenix, AZ 85013.
Otolaryngol Head Neck Surg. 1991 Dec;105(6):788-96. doi: 10.1177/019459989110500604.
Skull base tumors involving the clivus, petrous bone, and adjacent areas can be formidable lesions to successfully remove without causing significant neurologic deficits. At our institution in the last 5 years, twenty patients out of 103 patients with skull base tumors have undergone the supratentorial-infratentorial combined approach for removal of a neoplasm (nine schwannomas, six meningiomas, two epidermoids, one extensive basal cell carcinoma, one pontine cavernous malformation, and one basilar artery aneurysm). The average patient age was 43 years. The combined approaches in conjunction with the subtemporal exposure were retrosigmoid-retrolabyrinthine, retrosigmoid-translabyrinthine, or retrosigmoid-transcochlear. The choice depended upon the type and location of the lesion and the deficits noted preoperatively. Basically, the approach allowed communication of the middle fossa and posterior fossa by totally dividing the tentorium as much as necessary for effective surgical manipulations. Both sigmoid and superior petrosal sinuses are divided. There were no deaths. Postoperative neurologic deficits included temporary seventh nerve paralysis, sixth nerve weakness, fifth nerve sensory deficits, cerebrospinal fluid leaks, and hydrocephalus requiring a shunt. Overall, the results were very gratifying, considering the difficulties encountered in the surgical removal of these lesions.
累及斜坡、岩骨及相邻区域的颅底肿瘤是难以成功切除且不导致严重神经功能缺损的棘手病变。在我们机构过去5年中，103例颅底肿瘤患者中有20例接受了幕上-幕下联合入路切除肿瘤（9例神经鞘瘤、6例脑膜瘤、2例表皮样囊肿、1例广泛基底细胞癌、1例脑桥海绵状畸形和1例基底动脉瘤）。患者平均年龄为43岁。联合入路结合颞下暴露采用乙状窦后-迷路后、乙状窦后-经迷路或乙状窦后-经耳蜗入路。选择取决于病变的类型和位置以及术前发现的缺损。基本上，该入路通过尽可能完全切开小脑幕来实现中颅窝和后颅窝的连通，以进行有效的手术操作。乙状窦和岩上窦均被切断。无死亡病例。术后神经功能缺损包括暂时性面神经麻痹、展神经无力、三叉神经感觉缺损、脑脊液漏和需要分流的脑积水。总体而言，考虑到切除这些病变时遇到的困难，结果非常令人满意。
