Otani Naoki, Toyooka Terushige, Takeuchi Satoru, Tomiyama Arata, Nakao Yasuaki, Yamamoto Takuji, Wada Kojiro, Mori Kentaro
Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Department of Neurosurgery, Juntendo University Shizuoka Hospital, Shizuoka Prefecture, Japan.
J Neurol Surg B Skull Base. 2018 Oct;79(Suppl 4):S347-S355. doi: 10.1055/s-0038-1654703. Epub 2018 May 25.
Extradural temporopolar approach for paraclinoid lesions can provide extensive and early exposure of the anterior clinoid process, and complete mobilization and decompression of the optic nerve and internal carotid artery, which can prevent intraoperative neurovascular injury. The present study investigated the usefulness of our less invasive modified technique and discussed its operative nuances. We retrospectively reviewed medical charts of 80 consecutive patients with neoplastic (21 patients) and vascular lesions (59 patients) who underwent the modified extradural temporopolar approach between September 2009 and March 2014. Preoperative visual acuity worsened in 4 patients (5.0%) and worsening of visual field function occurred in 10 patients (12.5%). Postoperative outcome was good recovery in 71 patients, moderate disability in 6, severe disability in 2, and death in 1 (due to reruptured aneurysm). No operation-related mortality occurred in the series. Less invasive modified extradural temporopolar approach is safe and can be recommended for the surgical treatment of deeply located aneurysms and skull base tumors to reduce the risk of intraoperative optic neurovascular injury.
硬膜外颞极入路治疗鞍旁病变可早期广泛暴露前床突，对视神经和颈内动脉进行完全游离和减压，从而预防术中神经血管损伤。本研究探讨了我们改良的微创技术的有效性，并讨论了其手术细节。
我们回顾性分析了2009年9月至2014年3月期间连续80例行改良硬膜外颞极入路手术的肿瘤性病变（21例）和血管性病变（59例）患者的病历。
术前4例患者（5.0%）视力恶化，10例患者（12.5%）视野功能恶化。术后71例患者恢复良好，6例中度残疾，2例重度残疾，1例死亡（因动脉瘤再破裂）。该系列中未发生与手术相关的死亡。
改良的微创硬膜外颞极入路安全，可推荐用于深部动脉瘤和颅底肿瘤的手术治疗，以降低术中视神经血管损伤的风险。
