Department of Otolaryngology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Neurosurgery. 2010 May;66(5):1017-22. doi: 10.1227/01.neu.0000368102.22612.47.
This study reviewed the experience and outcomes of 1 surgical team (L.S.P., S.P.L.) using the transcrusal approach.
Ten-year retrospective review of 17 consecutive patients requiring transcrusal exposure of the petrous apex and upper brainstem was performed. The main outcome measures included hearing and facial nerve preservation as measured by standard audiography and postoperative assessment using the House-Brackmann scale.
Operative indications included meningioma (5 patients), epidermoid/dermoid cyst (3 patients), trigeminal schwannoma (3 patients), giant or large upper basilar artery aneurysm (3 patients), pontine cavernoma (1 patient), chondrosarcoma (1 patient), and clival melanocytoma (1 patient). Average tumor size was 3.6 cm. Complete resection was achieved in 50% of patients with petroclival tumors. Follow-up data were obtained for 14 patients at 20 +/- 4 months. Serviceable hearing was preserved in 58%. Sixty-four percent of patients demonstrated House-Brackmann stage I facial nerve function. Two patients died perioperatively (brainstem infarction). Two patients became hemiparetic, with 1 improving substantially. CSF leaks developed in 3 patients. Forty-seven percent of patients demonstrated cranial nerve V deficits. Forty-one percent of patients demonstrated deficits of cranial nerve III, IV, or VI. Vertigo, vestibular disturbance, hydrocephalus, temporal lobe contusion, or hematoma did not develop in any patients.
The transcrusal approach provides adequate exposure for most petroclival lesions and giant aneurysms of the upper basilar artery while offering the possibility of hearing preservation. Like all approaches to large tumors and aneurysms in this region, there is a significant risk of morbidity and mortality. However, this approach is an excellent alternative to other techniques that necessitate deliberate sacrifice of ipsilateral hearing.
本研究回顾了 1 个手术团队（L.S.P.、S.P.L.）使用经颅旁入路的经验和结果。
对 17 例连续需要经颅旁显露岩骨尖和上脑干的患者进行了 10 年回顾性研究。主要观察指标包括听力和面神经的保留情况，通过标准听力测试和术后 House-Brackmann 量表评估来测量。
手术指征包括脑膜瘤（5 例）、表皮样/皮样囊肿（3 例）、三叉神经鞘瘤（3 例）、巨大或大型基底动脉上段动脉瘤（3 例）、桥脑海绵状血管瘤（1 例）、软骨肉瘤（1 例）和颅底黑色素细胞瘤（1 例）。肿瘤平均大小为 3.6cm。50%的岩斜区肿瘤患者实现了完全切除。14 例患者获得了 20±4 个月的随访数据。58%的患者保留了可使用的听力。64%的患者面神经功能为 House-Brackmann Ⅰ级。2 例患者围手术期死亡（脑干梗死）。2 例患者出现偏瘫，其中 1 例显著改善。3 例患者发生脑脊液漏。47%的患者出现第 V 颅神经功能障碍。41%的患者出现第 III、IV、或 VI 颅神经功能障碍。没有患者出现眩晕、前庭功能障碍、脑积水、颞叶挫裂伤或血肿。
经颅旁入路为大多数岩斜区病变和基底动脉上段巨大动脉瘤提供了充分的显露，同时有可能保留听力。与该区域所有大型肿瘤和动脉瘤的入路一样，存在显著的发病率和死亡率风险。然而，对于需要故意牺牲同侧听力的其他技术来说，这种方法是一个极好的替代方案。
