Gupta Sunil K
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Br J Neurosurg. 2009 Jun;23(3):287-92. doi: 10.1080/02688690802716129.
Various transpetrosal approaches have been described for excision of lesions extending into both the middle fossa and the upper petroclival region. These approaches may be associated with significant morbidity. Six patients with lesions along the medial part of the middle fossa and the upper petroclival region were operated by the trans-sylvian transtentorial approach. The surgical corridor was along the tentorial edge with excision of the tentorium providing adequate access to the tumour without the need for petrosectomy. Three patients had a trigeminal schwanomma, one each had a petroclival meningioma, clival chordoma and an epidermoid tumour. In 5 patients a total/near total excision was achieved while in one patient with petroclival meningioma, a subtotal excision was possible. All patients improved clinically after the surgery. There was no procedure related morbidity. The transsylvian transtentorial approach provides adequate access to upper petroclival lesions allowing the tumours in this region to be removed without the need for a petrosal resection.
对于切除延伸至中颅窝和上岩斜区的病变，已有多种经颞骨入路被描述。这些入路可能会伴有显著的并发症。6例中颅窝内侧部和上岩斜区病变患者采用经侧裂经小脑幕入路进行手术。手术通道沿着小脑幕边缘，切除小脑幕可提供足够的肿瘤暴露，而无需进行岩骨切除术。3例患者患有三叉神经鞘瘤，1例分别患有岩斜脑膜瘤、斜坡脊索瘤和表皮样肿瘤。5例患者实现了全切/近全切，而1例岩斜脑膜瘤患者仅行次全切除。所有患者术后临床症状均有改善。无手术相关并发症。经侧裂经小脑幕入路可提供足够的上岩斜区病变暴露，无需进行岩骨切除即可切除该区域的肿瘤。
