摘要
目的：探讨颞下经岩经小脑幕入路与经岩乙状窦前入路的特点,并结合文献比较它们的异同点。
方法：回顾性分析9例骑跨颅中、后窝三叉神经鞘瘤患者的临床资料,其中颞下经岩经小脑幕入路5例、经岩乙状窦前入路4例,以这两种手术入路术后面神经损伤、脑脊液漏的例数为指标,采用四格表资料的Fisher确切概率法进行统计学分析。
结果：肿瘤全切除8例,次全切除1例,无颅内感染,无手术死亡,术前颅神经症状均获不同程度改善；随访6个月-48个月,次全切除患者术后24个月复发；两种手术入路术后面神经损伤及脑脊液漏的百分比差异均无统计学意义(P>0.05)。
结论：这两种手术入路各有特点；术后面神经损伤、脑脊液漏与手术入路本身无关,主要取决于术者扎实的显微手术基本功和丰富的显微手术经验；选择手术入路时,应根据肿瘤的特点及患者的体质综合分析,遵循个体化、微侵袭治疗原则。
Objective:To investigate characteristics of Temporal base transpetrosal transtentorial approach and Presigmoid petrosal approach, and compare the similarities and differences of them based on related literatures.
Methods:Clinical data of 9 patients with MP type trigeminal schwannoma were analyzed respectively,5 cases via Temporal base transpetrosal transtentorial approach,4 cases via Presigmoid petrosal approach, cases of facial nerve injury and cerebrospinal fluid leakage after surgery by two surgical approaches were analyzed with Fisher probabilities in 2×2 table.
Results:Total tumor resection was achieved in 8 patients, subtotal resection in l,no intracranial infection,no death, The neurological deficits were improved to different extents postoperatively;during a follow-up period of 6 months to 48 months,tumor recurrence was found in 1 patient for subtotal resection;no statistically significant differences were found in the value of facial nerve injury and cerebrospinal fluid leakage after surgery by two surgical approaches (P> 0.05).
Conclusions:Temporal base transpetrosal transtentorial approach and Presigmoid petrosal approach have their own characteristics, facial nerve injury and cerebrospinal fluid leakage after surgery has nothing to do with the surgical approach, depends mainly on the surgeon's microsurgical solid basic skills and rich experience in microsurgery;when selecting,we should be based on tumor characteristics and physical fitness of patients, follow individualized, minimally invasive treatment principles.
引文
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