Somekawa Y, Asano K, Hata M
Department of Otolaryngology, Tonan Hospital, Sapporo.
Nihon Jibiinkoka Gakkai Kaiho. 1997 Jul;100(7):782-9. doi: 10.3950/jibiinkoka.100.782.
En bloc resection of the temporal bone for squamous cell carcinoma of the middle ear was performed by the postauricular transtemporal and retromastoid approaches. The patient was a 70-year-old woman whose tumor extended to the middle and posterior cranial fossae. Temporal and retromastoid craniotomies were carried out, then the temporal dura and the cerebellar dura, and the transverse and sigmoid sinuses were exposed. The temporal dura and the cerebellar dura were opened, and the transverse sinus was ligated at the junction with the sigmoid sinus. After that, the tentorial dura was incised, the incision extending anteriorly to the middle cranial fossa and transecting the superior petrosal sinus. Consequently, a wide view into the middle and the posterior cranial fossae was obtained. In the posterior fossa, cranial nerves VII and VIII were divided. On the other hand, nerves IX, X and XI were preserved at the dural incision on the posterior surface of the temporal bone. Subsequently, in the area of the carotid canal, the temporal bone was drilled toward the medial side of the internal auditory canal and also posteriorly down to the jugular bulb. At this stage, the temporal bone and the soft tissue attachments, such as the middle and posterior cranial fossa dura, and the sigmoid sinus, were separated from the pyramidal apex and the clivus. The dural defect was repaired with a free pericranial graft. A rectus abdominis muscle flap was transferred to reconstruct the defect of the skull base resulting from the temporal bone resection. Postoperative complications like CSF leakage, meningitis and lower cranial nerve damage, were not seen after the treatment. The patient has shown no evidence of recurrence for the 28 months since the surgical treatment, and has not complained of any problems with swallowing or conducting conversations in daily life. With the contribution of recent developments in skull base and reconstruction surgery, more aggressive en bloc resection of the temporal bone can be carried out on patients with advanced middle ear carcinoma. These developments will also make it possible for patients whose prognosis was previously thought to be poor to have a chance for a cure.
采用耳后经颞骨和乳突后入路对中耳鳞状细胞癌进行整块颞骨切除术。患者为一名70岁女性，肿瘤已扩展至中颅窝和后颅窝。进行了颞骨和乳突后开颅手术，然后暴露颞部硬脑膜、小脑硬脑膜以及横窦和乙状窦。打开颞部硬脑膜和小脑硬脑膜，在横窦与乙状窦交界处结扎横窦。之后，切开小脑幕硬脑膜，切口向前延伸至中颅窝并横断岩上窦。从而获得了对中颅窝和后颅窝的广阔视野。在后颅窝，切断了面神经VII和听神经VIII。另一方面，在颞骨后表面的硬脑膜切口处保留了IX、X和XI神经。随后，在颈动脉管区域，向内侧朝向内耳道并向后一直钻到颈静脉球来处理颞骨。在此阶段，将颞骨以及中颅窝和后颅窝硬脑膜、乙状窦等软组织附着物从锥体尖和斜坡分离。用游离颅骨膜移植修复硬脑膜缺损。转移腹直肌瓣以重建因颞骨切除导致的颅底缺损。治疗后未出现脑脊液漏、脑膜炎和下颅神经损伤等术后并发症。自手术治疗以来的28个月里，患者未出现复发迹象，日常生活中也未抱怨吞咽或交谈有任何问题。随着颅底和重建手术的最新进展，对于晚期中耳癌患者可以进行更积极的整块颞骨切除术。这些进展也将使那些以前被认为预后较差的患者有治愈的机会。
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