Cheung Steven W, Russell Matthew S, Pross Seth E
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, United States.
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, United States.
Handb Clin Neurol. 2020;170:115-131. doi: 10.1016/B978-0-12-822198-3.00034-3.
Posterior fossa meningiomas that impinge on structures of the temporal bone or clivus may be difficult to access for optimal resection that maximizes tumor control and minimizes short- and long-term morbidities. To address this challenge, the contemporary neurosurgery-neurotology team works collaboratively by managing patients jointly at every stage of care: preoperative evaluation, intraoperative intervention, and postoperative treatment. The neurotologist is important at all stages of posterior fossa meningioma surgery. First, detailed preoperative evaluation of auditory, facial, vestibular, and lower cranial nerve integrity enables assessment of new neurologic deficit risk, prognosis of functional recovery, and pros and cons of candidate surgical approaches. Second, intraoperative partitioning of surgical steps by provider and adopting an overlapping tumor resection philosophy creates an efficient and confident surgical team built on trust. Third, postoperative closure of cerebrospinal fluid leak and treatment of facial weakness, audiovestibular dysfunction, and voicing and swallowing impairments organized by the neurotologist reduces the impact of negative outcomes. The role of the neurotologist in posterior fossa meningioma surgery is to deliver nuanced evaluative metrics, facilitate shared decision making, perform precise bone and soft tissue microsurgery, and mitigate perioperative morbidities.
侵犯颞骨或斜坡结构的后颅窝脑膜瘤可能难以进行最佳切除，以实现最大程度的肿瘤控制并将短期和长期发病率降至最低。为应对这一挑战，当代神经外科 - 神经耳科学团队在护理的每个阶段共同管理患者，包括术前评估、术中干预和术后治疗，以此展开协作。神经耳科医生在后颅窝脑膜瘤手术的各个阶段都很重要。首先，对听觉、面部、前庭和低位颅神经完整性进行详细的术前评估，有助于评估新的神经功能缺损风险、功能恢复预后以及候选手术方法的利弊。其次，由医护人员对手术步骤进行术中划分，并采用重叠肿瘤切除理念，可打造一个基于信任的高效且自信的手术团队。第三，由神经耳科医生负责术后脑脊液漏的封闭以及面部无力、听觉前庭功能障碍、发声和吞咽障碍的治疗，可减少不良后果的影响。神经耳科医生在后颅窝脑膜瘤手术中的作用是提供细致入微的评估指标、促进共同决策、进行精确的骨和软组织显微手术，并减轻围手术期发病率。
