Cass S P, Sekhar L N, Pomeranz S, Hirsch B E, Snyderman C H
Department of Otolaryngology, University of Pittsburgh School of Medicine, Eye and Ear Institute of Pittsburgh, PA 15213, USA.
Am J Otol. 1994 Jul;15(4):474-84.
The surgical removal of intradural petroclival tumors of any size is demanding because of the restricted surgical exposure and relation of the tumor with the brain stem, cranial nerves, and vertebrobasilar artery and branches. When petroclival tumors are large or giant sized and involve multiple areas of the clivus, adequate surgical exposure is difficult to achieve, yet is critical for safe tumor removal. In 17 patients with extensive petroclival tumors, total removal of the petrous bone was performed to gain a wide and shallow surgical exposure. This report details the intraoperative and postoperative complications, cranial nerve status, pre- and postoperative disability scores, and extent of tumor resection in these 17 patients. Deterioration of facial nerve function was the most common new cranial nerve injury following surgery. Three patients suffered major neurologic complications; six other patients suffered significant but temporary neurologic complications. Gross total tumor resection was accomplished in 9 of 17 patients, and most patients (15/17) maintained or improved their disability status. Tumor residual was related to cavernous sinus involvement, vascular encasement, or brainstem pial invasion. Total petrosectomy is an intensive and complex approach with inherent morbidity and thus should be reserved for extensive petroclival tumors that cannot be removed using less complicated approaches.
由于手术暴露受限以及肿瘤与脑干、颅神经、椎基底动脉及其分支的关系，任何大小的硬膜内岩斜区肿瘤的手术切除都具有挑战性。当岩斜区肿瘤体积较大或巨大且累及斜坡的多个区域时，难以实现充分的手术暴露，但这对于安全切除肿瘤至关重要。在17例广泛的岩斜区肿瘤患者中，为获得宽阔且浅的手术暴露而进行了岩骨全切除。本报告详细介绍了这17例患者的术中及术后并发症、颅神经状况、术前及术后残疾评分以及肿瘤切除范围。面神经功能恶化是术后最常见的新发颅神经损伤。3例患者出现严重神经并发症；另外6例患者出现明显但短暂的神经并发症。17例患者中有9例实现了肿瘤全切，大多数患者（15/17）的残疾状况保持稳定或有所改善。肿瘤残留与海绵窦受累、血管包绕或脑干软膜侵犯有关。岩骨全切除术是一种复杂且有潜在并发症的手术方法，因此应仅用于无法采用较简单方法切除的广泛岩斜区肿瘤。
