目的探讨经鼻内镜手术治疗岩斜区及颞下窝肿瘤的可行性和外科手术技术。方法2002年1月至2005年2月间对17例侵犯岩斜坡或颞下窝肿瘤单独采用内镜经鼻手术入路进行了治疗,详尽阐述外科手术技术及介绍典型病例。结果17例患者中脊索瘤5例,脑膜瘤4例,颅咽管瘤1例,神经鞘膜瘤1例,血管母细胞瘤1例,嗅神经母细胞瘤1例,恶性淋巴瘤1例,脊索肉瘤1例,腮腺癌颅底转移1例,甲状腺癌颅底转移1例。15例患者术后复查影像显示肿瘤全部被切除,2例大部分切除。所有病例随访5～43个月,良性肿瘤中有1例脊索瘤术后5个月复发,后行2次手术,其余均无复发。5例恶性肿瘤患者均随访2年以上,无复发或死亡。术后1例蛛网膜下腔出血、2例出现脑脊液鼻漏,其中1例经保守治疗痊愈、1例经2次鼻内镜手术修补成功。无颅内感染及死亡病例。结论经鼻内镜外科技术为岩斜区和颞下窝肿瘤的外科治疗提供了一种新的方法。这种入路能够简单和迅速地到达岩斜区和颞下窝,且既能够达到微侵袭目的,又能够满足全切肿瘤的要求。但需要术者熟练掌握内镜颅底解剖学、内镜手术操作及对各区域病变丰富的外科手术经验。术中应用影像导航系统将有助于识别解剖标志,使手术过程更加安全。 Objective To investigate the feasibility and surgical technique of transnasal endoscopic surgery for petroclival and infratemporal fossa tumors. Methods From January 2002 to February 2005, 17 cases of invasion of rock slopes or infratemporal fossa tumors were treated by endoscopic nasal approach alone. The surgical techniques and typical cases were introduced in detail. Results Among the 17 patients, 5 were chordoma, 4 were meningioma, 1 was craniopharyngioma, 1 was neurovascular, 1 was hemangioblastoma, 1 was neuroblastoma, 1 was neuroblastoma, 1 was malignant lymphoma, 1 cases of chorda sarcoma, 1 case of parotid gland metastasis of skull base and 1 case of metastasis of base of thyroid carcinoma. Fifteen patients underwent a review of the images showing that the tumor was completely resected and most of the resections were performed in 2 cases. All cases were followed up for 5 to 43 months. One case of benign tumor had recurrence 5 months after operation, and 2 cases were followed up. The others had no recurrence. Five patients with malignant tumors were followed up for more than 2 years without recurrence or death. One case had subarachnoid hemorrhage and two cases had cerebrospinal fluid rhinorrhea. One case was cured by conservative treatment, and one case was successfully repaired by two endoscopic sinus surgery. No intracranial infection and deaths. Conclusion Endoscopic sinus surgery provides a new method for the surgical treatment of petroclival and infratemporal tumors. This approach can reach the petroclival region and the infratemporal fossa simply and rapidly, and can not only achieve the purpose of micro-invasion, but also meet the requirements of the total tumor. However, the surgeon is required to master the endoscopic skull base anatomy, endoscopic surgical procedures and extensive surgical experience in various regions. Intraoperative application of image navigation system will help identify anatomical landmarks, make the operation process more secure.