摘要目的 探讨扩大中颅底硬膜外入路经岩骨窗切除哑铃型三叉神经鞘瘤的治疗效果.方法 我科2007 - 2010年应用扩大中颅底硬膜外入路经岩骨窗切除哑铃型三叉神经鞘瘤21例.术前CT及MRI评估位于中、后颅窝肿瘤大小及岩骨侵蚀程度,分为三种类型:Mp型12例,MP型7例及mP型2例.结果 肿瘤全切19例,次全切2例,无手术死亡,术后出现新的暂时性脑神经麻痹4例,1例脑脊液漏,经腰大池引流脑脊液治愈.随访18例,时间6个月-3年(平均22.4个月),2例次全切除肿瘤复发,均位于后颅窝,经乙状窦后入路再次手术治愈.结论 扩大中颅底硬膜外入路经岩骨窗切除哑铃型三叉神经鞘瘤是一种有效的治疗方法,尤其对于肿瘤明显侵蚀破坏岩骨者.然而,如果后颅窝肿瘤部分过大时,该入路显露不足,难以全切肿瘤.

abstractsObjective To evaluate extended middle cranial fossa extradural approach using the Petrous Window for surgery on dumbbell shaped neurinomas.Method During 4 year period between 2007 and 2010,consecutive 21 cases of dumbbell shaped trigeminal neurinomas were treated through extended middle cranial fossa extradural approach using the petrous window.The configuration of the tumor mass was assessed on MRI and CT by measuring its long diameter in the middle and posterior fossa and the width of petrous erosion.Tumors were then classified into three types based on their distribution over the petrous ridge( Mp type =12;MP type =7 and mP type =2).Results Total removal was achieved in 19 patients,subtotally removed in 2.No patient dead of the surgery.A new dysfunction of cranial nerve was observed in 4 patients.The postoperative cerebrospinal fluid leakage was found in 1 case,which was cured by lumbar drainage.After a mean follow - up of 22.4 months (6 -36 months) for 18 patients,16 cases showed no evidence of tumor recurrence and 2 patients with a subtotal removal developed a recurrence after surgery,in the posterior fossa,which was cured by retrosigmoid approach.Conclusion The extended middle cranial fossa extradural approach using the Petrous Window could be an effective method for removing dumbbell shaped trigeminal schwannoma,particularly in cases of wide petrous erosion from the tumor.However,the tumor has a larger posterior fossa components,this approach may not provide adequate exposure to achieve a total resecction.