岩斜区肿瘤的显微手术治疗

目的 探讨岩斜区肿瘤的显微手术治疗方法及其效果。方法 自2010年10月至2014年10月收治岩斜区肿瘤23例，分别采用颞下经小脑幕入路（11例）、乙状窦后经小脑幕入路（7例）和幕上幕下（颞下-乙状窦后）联合入路（5例）进行手术切除。结果 23例岩斜区肿瘤中脑膜瘤9例，神经鞘瘤12例，胆脂瘤2例。颞下经小脑幕入路11例中，肿瘤全切9例，次全切2例；乙状窦后经小脑幕入路7例均全切除；幕上幕下联合入路5例中，次全切4例，部分切除1例。23例患者随访6~36个月；术前Karnofsky功能状态评分为（83.0±7.0）分，术后1月为（75.2±9.0）分，术后6个月为（80.0±6.0）分；6例次全切除及1例部分切除患者术后1月行伽玛刀治疗，在随访时间内未见肿瘤复发。结论 根据岩斜区肿瘤的不同类型，选择颞下经小脑幕入路、乙状窦后经小脑幕入路和幕上幕下联合入路，可以提供肿瘤全切率，减少并发症，提高手术疗效。

Microsurgery via three kinds of approaches for petroclival tumors

Objective To explore the Methods of microsurgery via three kinds of approaches for the petroclival tumors. Methods Of 23 petroclival tumors including 9 meningiomas, 12 neurilemmomas and 2 cholesteatomas, 11 were treated by microsurgery via the subtemporal transtentorial approach, 7 by microsurgery via the retrosigmoid transtentorial approach and 5 by microsurgery via the combined supra- and infratentorial approach. Therapeutic effects were evaluated by Karnofsky performance scale (KPS). Results The scores of KPS were (83.04±7.03) points before the operation in 23 patients with petroctival tumors, of whom, 16(69.6%) received the total resection of the tumors, 6 (26.1%) subtotal and 1 (4.3%) partial. No patients died. The following-up from 6 to 36 months showed that the scores of KPS were (75.21±8.98) points 1 month after the surgery and (80.00±6.03) points 6 months after the surgery. New damage to the cranial nerve occurred due to the operation in 10 patients. Conclusions The subtemporal transtentorial approach, retrosigmoid transtentorial approach and combined supra- and infratentorial approach are ideal approaches of the microsurgery for the different types of the petroclival tumors, which can be exposed extensively with minimal injury by the microsurgery via the above-mentioned approaches.