Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
Acta Neurochir (Wien). 2021 Oct;163(10):2881-2894. doi: 10.1007/s00701-021-04962-5. Epub 2021 Aug 21.
Petrous bone lesions (PBLs) are rare with few reports in the neurosurgical literature. In this study, the authors describe our current technique of extradural subtemporal approach (ESTA). The objective of this study was to evaluate the role and efficacy of ESTA for treatment of the PBLs. To our knowledge, this is the largest reported clinical series of using an ESTA-treated PBLs in which the clinical outcomes were evaluated.
Between 1994 and 2019, 67 patients with PBLs treated by ESTA were retrospectively reviewed. Extent of resection, neurological outcomes, recurrence rate, and surgical complications were evaluated and compared with previous studies. The indications, advantages, limitations, and outcomes of ESTA were analyzed according to pathology.
This series included 7 facial nerve schwannomas (10.4%), 16 cholesterol granulomas (23.9%), 16 chordomas (23.9%), 6 chondrosarcomas (9%), 5 trigeminal schwannomas (7.5%), 9 epidermoids/dermoids (13.4%), and 8 other pathologies (11.9%). The most common location of PBLs operated with ESTA was at the petrous apex and rhomboid areas (68.7%). Gross total resection was achieved in 35 (55.6%). Symptomatic improvement occurred in 56 patients (83.6%). Complications occurred in 7 (10.4%) of cases including one mortality. Nine patients (17%) had recurrence within the mean follow-up 71 months. Compared to previous literature, our results demonstrated comparable outcomes but with higher rates of hearing and facial nerve preservation as well as minimal morbidity. From our results, ESTA is an effective therapeutic option for lesions located at the rhomboid and petrous apex, particularly when patients presented with intact facial and hearing function.
Our series demonstrated that ESTA provided satisfactory outcomes with excellent benefits of hearing and facial function preservation for patients with petrous bone lesions. ESTA should be considered as a safe and effective therapeutic option for selected patients with PBLs.
岩骨病变（PBLs）较为罕见，在神经外科学文献中鲜有报道。在本研究中，作者描述了他们目前采用的颅中窝经颞下入路（ESTA）技术。本研究的目的是评估 ESTA 治疗 PBL 的作用和疗效。据我们所知，这是最大的一组采用 ESTA 治疗 PBL 的临床病例系列，评估了其临床结果。
1994 年至 2019 年间，回顾性分析了 67 例采用 ESTA 治疗的 PBL 患者。评估了切除程度、神经功能预后、复发率和手术并发症，并与以往的研究进行了比较。根据病理学分析了 ESTA 的适应证、优点、局限性和结果。
本研究系列包括 7 例面神经神经鞘瘤（10.4%）、16 例胆脂瘤（23.9%）、16 例脊索瘤（23.9%）、6 例软骨肉瘤（9%）、5 例三叉神经神经鞘瘤（7.5%）、9 例表皮样囊肿/皮样囊肿（13.4%）和 8 例其他病变（11.9%）。采用 ESTA 手术的 PBL 最常见部位是岩骨尖和菱形体区（68.7%）。35 例（55.6%）达到大体全切除。56 例（83.6%）患者症状改善。7 例（10.4%）发生并发症，其中 1 例死亡。9 例（17%）患者在平均 71 个月的随访中复发。与以往文献相比，本研究结果显示出相似的结果，但听力和面神经保留率更高，发病率更低。根据本研究结果，ESTA 是位于菱形体和岩骨尖病变的有效治疗选择，特别是当患者存在完好的听力和面神经功能时。
本研究系列表明，ESTA 为岩骨病变患者提供了满意的结果，对面神经和听力功能的保护具有显著的优势。对于 PBL 患者，ESTA 应被视为一种安全有效的治疗选择。
