Leonetti J P, Smith P G, Kletzker G R, Izquierdo R
Department of Otolaryngology-Head and Neck Surgery, Loyola Center for Cranial Base Surgery, Maywood, Illinois, USA.
Am J Otol. 1996 May;17(3):438-42.
Primary malignancies of the temporal bone may originate in the external auditory canal, the middle ear, the endolymphatic sac, or the eustachian tube. The surgical treatment of advanced tumors in these regions is strictly dependent upon the radiographic delineation of disease extent and the tumor relationship to adjacent neurovascular structures. Twenty-six cases of stage III or IV squamous cell carcinoma of the temporal bone were retrospectively reviewed to correlate preoperative clinicoradiographic analysis with intraoperative findings. The following patterns of tumor invasion were identified: (a) superior erosion through the tegmen tympani into the middle cranial fossa; (b) anterior extension into the glenoid fossa and infratemporal space; (c) inferior growth through the hypotympanum and jugular foramen; (d) posterior involvement of the mastoid air cells; and (e) medial involvement of the middle ear and carotid canal. While otic capsule erosion was uncommon, several of these patients did present with lower cranial nerve palsies. Complex surgical procedures exist for the en bloc resection of advanced temporal bone cancers. Appropriate operative planning must be based upon a knowledge of potential patterns of tumor extension and meticulous radiographic assessment.
颞骨原发性恶性肿瘤可能起源于外耳道、中耳、内淋巴囊或咽鼓管。这些区域晚期肿瘤的手术治疗严格取决于疾病范围的影像学界定以及肿瘤与相邻神经血管结构的关系。回顾性分析26例Ⅲ期或Ⅳ期颞骨鳞状细胞癌病例，以将术前临床影像学分析与术中发现相关联。确定了以下肿瘤侵犯模式：(a) 经鼓室盖向上侵蚀至中颅窝；(b) 向前延伸至关节窝和颞下间隙；(c) 经下鼓室向下生长并通过颈静脉孔；(d) 乳突气房后部受累；(e) 中耳和颈动脉管内侧受累。虽然听骨链侵蚀并不常见，但其中一些患者确实出现了低位颅神经麻痹。对于晚期颞骨癌的整块切除存在复杂的手术方法。适当的手术规划必须基于对肿瘤扩展潜在模式的了解和细致的影像学评估。
