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目的探讨锁孔手术入路应用于后颅窝肿瘤手术的疗效及手术技巧。方法后颅窝肿瘤患者43例,其中CP角肿瘤20例(听神经瘤18例、脑膜瘤、室管膜瘤各1例)、岩斜区脑膜瘤8例、桥脑肿瘤6例(胶质瘤3例、转移癌2例、胶质增生1例)、四脑室肿瘤4例(髓母细胞瘤、室管膜瘤各2例)、小脑半球肿瘤3例(转移癌2例、血管母细胞瘤1例)、天幕缘脑膜瘤、枕大孔鞍区CP角胆脂瘤各1例。根据肿瘤解剖位置及其特性,选择颞下、乳突后或枕下正中锁孔入路进行手术切除。结果43例肿瘤全切除37例(86.0%),次全切除5例(11.6%),大部分切除1例(2.3%)。无与锁孔入路相关并发症出现。18例听神经瘤患者均肿瘤全切除,面神经解剖保留15例(83.3%),其中1例患者手术后第2天因脑干水肿死亡。8例岩斜区脑膜瘤患者,5例肿瘤全切除,2例次全切除,1例大部分切除,其中2例患者术后遗有轻度偏瘫,1例有轻度面瘫。6例桥脑肿瘤患者,3例肿瘤全切除,3例次全切除,术后无神经功能障碍。其他患者肿瘤均全切除,除1例巨大胆脂瘤患者复视在术后无明显好转外,无其他神经功能障碍。结论锁孔入路进行后颅窝肿瘤手术具有安全、简捷、微创的效果,是神经外科手术发展的一个方向。
Objective To evaluate the efficacy and surgical technique of keyhole approach for posterior fossa tumor surgery. Methods Forty-three patients with posterior fossa tumors were examined. Among them, there were 20 cases of angle-angle tumors (18 cases of acoustic neuroma, 1 case of meningioma and ependymoma), 8 cases of petroclival meningiomas, 6 cases of pontine tumors 3 cases, 2 cases of metastatic carcinoma, 1 case of glial hyperplasia), 4 cases of four ventricle tumors (2 cases of medulloblastoma and ependymoma), 3 cases of cerebellar hemisphere tumors (2 cases of metastatic carcinoma, 1 case), apical meningiomas, and 1 case of periapical cholesteatoma. According to the location of tumor anatomy and its characteristics, select the inferior temporal, mastoid or suboccipital median keyhole approach for surgical resection. Results Forty-seven cases (86.0%) underwent total resection, five cases (11.6%) underwent subtotal resection and one case (2.3%) underwent resection. No keyhole related complications occurred. Eighteen patients with acoustic neuroma underwent total resection of the tumor. Fifteen cases (83.3%) had facial nerve anatomy. One patient died of brain stem edema on the second day after operation. In 8 patients with petroclival meningiomas, 5 tumors were resected completely, 2 were subtotally resected and 1 was mostly resected. Two of them had minor hemiparesis and one had mild facial paralysis. 6 cases of pontine tumor patients, 3 cases of total tumor resection, subtotal resection in 3 cases, no postoperative neurological dysfunction. All patients with other tumors were resected, except one case of patients with giant cholesteatoma diplopia showed no significant improvement after surgery, no other neurological dysfunction. Conclusion Keyhole approach posterior fossa tumor surgery with safe, simple, minimally invasive effect is a neurosurgery development in one direction.