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目的 :探讨适宜外科治疗桥小脑角区和岩斜区病变的手术途径。方法 :采用乙状窦前小脑幕上下联合径路 ,手术治疗 9例跨越小脑幕上下的桥小脑角、岩尖、岩斜区肿瘤 ,其中神经鞘瘤 3例 ,脑膜瘤 6例 ;1例大脑后动脉血栓性动脉瘤。结果 :病变全切 6例 ,次全切除 4例。术后 1例出现脑脊液漏并发颅内感染并失访。其余9例头痛、头晕症状均明显好转或消失 ;其中 4例术前面瘫患者 ,1例术后稍好转 ,3例无改变 ;3例术前并发小脑症状的患者术后有明显改善 ;术前并发的其他脑神经受累症状术后无好转 ;预后按Samii等标准判定 ,7例恢复好 ,1例预后一般 ,1例预后差。术后听力无改变 5例 ,听力下降 2 0dBHL 2例 ,下降 30dBHL 1例 ,下降 6 0dBHL 1例。结论 :乙状窦前小脑幕上下联合径路术野宽阔、清晰 ,无需过度牵拉脑组织 ,便于切除桥小脑角区、岩斜区占位病变 ,并能较好地保护脑神经功能。
Objective: To explore the surgical approach suitable for the surgical treatment of cerebellopontine angle and petroclival disease. Methods: Nine patients with supraoparathyoid cerebellopontine angle, petrous apex and petroclival area tumors were treated by supratentorial and supratentorial approach of the sigmoid sinus. Among them, 3 were schwannoma and 6 were meningioma; 1 were posterior Arterial thrombotic aneurysm. Results: 6 cases of complete lesion, subtotal resection in 4 cases. One patient had cerebrospinal fluid leakage complicated with intracranial infection and lost follow-up. The remaining 9 cases of headache, dizziness symptoms were significantly improved or disappeared; 4 cases of preoperative facial paralysis patients, 1 case improved slightly after surgery, 3 cases no change; 3 cases of preoperative cerebellar symptoms were significantly improved after surgery; preoperative Concurrent symptoms of other cranial nerves affected no improvement after surgery; the prognosis was judged according to Samii et al. 7 cases recovered well, 1 case had a general prognosis, and 1 case had poor prognosis. There were 5 cases with no change in hearing, 2 cases with 20 dBHL hearing loss, 1 case decreased 30 dBHL and 1 case 6 0 dBHL decreased. CONCLUSION: The superior and inferior approach of supratentorial and supratentorial commissural approach is broad and clear. Without excessively pulling the brain tissue, it is easy to excise the cerebellopontine angle region and petroclival region, and protect the function of the cranial nerves.