ANTERIOR TRANSPETROSAL-TRANSTENTORIAL APPROACH FOR SPHENOPETROCLIVAL MENINGIOMAS - SURGICAL METHOD AND RESULTS IN 10 PATIENTS
ANTERIOR TRANSPETROSAL-TRANSTENTORIAL APPROACH FOR SPHENOPETROCLIVAL MENINGIOMAS - SURGICAL METHOD AND RESULTS IN 10 PATIENTS
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DOI：
10.1227/00006123-199106000-00014
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发表时间：
1991-06-01
期刊：
影响因子：
4.8
通讯作者：
TOYA, S
中科院分区：
文献类型：
--
作者：
KAWASE, T;SHIOBARA, R;TOYA, S
本文报告了一种新的手术方法和10例延伸至鞍旁的岩斜区脑膜瘤（蝶岩斜区脑膜瘤）的手术结果。 通过中颅窝开颅术对前岩骨进行最小但有效的硬膜外切除，可直接观察斜坡区，保留颞桥静脉和耳蜗器官。 硬脑膜切口向前延伸至Meckel's腔，在海绵窦受侵的病例中，通过三叉神经游离扩大帕金森三角。 该入路提供了从中斜坡到海绵窦的良好视野。 在桥脑表面直视下，可清除硬膜外和硬膜内的肿瘤肿块和硬膜附件。 这种入路将损伤下颅神经和牵拉损伤颞叶和脑干的风险降至最低。 7例患者实现肿瘤全切除，无死亡。 8例患者有一个令人满意的术后过程中，眼外麻痹是他们的主要投诉。 肿瘤切除范围取决于肿瘤与颈动脉的粘连程度，手术并发症取决于肿瘤对脑干的侵犯程度。 在3例肿瘤次全切除的患者中，只有1例在随访期间（6个月-6年）经历了肿瘤再生长并接受了第二次手术。
This report presents a new surgical method and the results in 10 patients with petroclival meningiomas extending into the parasellar region (sphenopetroclival meningiomas). Minimal but effective extradural resection of the anterior petrous bone via a middle fossa craniotomy offered a direct view of the clival area with preservation of the temporal bridging veins and cochlear organs. The dural incision was extended anteriorly to Meckel's cave, and in cases with invasion of the cavernous sinus, Parkinson's triangle was enlarged by mobilization of the trigeminal nerve. This approach offered an excellent view from the mid-clivus to the cavernous sinus. Extra- as well as intradural tumor masses and dural attachments could be cleared under direct view of the pontine surface. The risk of injury to the lower cranial nerve and of retraction damage to the temporal lobe and brain stem were kept minimal by this approach. Total tumor resection was achieved in 7 patients, with no resultant mortality. Eight patients had a satisfactory postsurgical course, extraocular paresis being their main complaint. The extent of tumor resection depended on the degree of tumor adhesion to the carotid artery, and operative morbidity on the degree of tumor invasion of the brain stem. Of the 3 patients in whom subtotal tumor removal was achieved, only one experienced regrowth of the tumor and underwent a second operation during the follow-up period (6 months-6 years).