颞下窝B型径路切除侧颅底肿瘤临床分析

Infratemporal fossa type B approach to tumors of the lateral skull baseXUE

摘要:

目的探讨颞下窝B型径路在侧颅底肿瘤中的适应证及手术效果。 方法回顾性分析2015年1月—2018年6月采用颞下窝B型径路治疗8例侧颅底肿瘤患者的临床资料，其中横纹肌肉瘤1例，成熟型畸胎瘤1例，骨巨细胞瘤1例，颞骨鳞癌1例，巨细胞修复性肉芽肿2例，胆脂瘤2例。结果3例患者病变范围主要累及颈静脉孔区、颈内动脉、岩尖；5例患者病变范围主要累及颧弓、颞下颌关节、中颅底甚至颞叶。7例单纯行颞下窝B型径路，1例患者行颞下窝B型径路联合经耳蜗径路，8例患者均完全切除病变。所有患者术后1周复查头颅MRI，均未见病变残留。4例患者术后为重度传导性或混合性听力下降，另外4例患者术后为极重度感音神经性听力下降。术前面瘫者2例，术后无加重；术前面神经功能正常者，术后2例出现面瘫，其中1例为联合经耳蜗入路患者术中将面神经进行移位，另外1例由于恶性肿瘤已侵犯面神经，术中将受侵犯的面神经切除。所有患者随访期间均无脑脊液耳漏、颅内出血，颅内感染、偏瘫、死亡等严重术后并发症。 结论颞下窝B型径路在暴露颈内动脉垂直段和水平段、岩尖等部位极具优势，同时这一径路也可用于切除累及颧弓、颞下颌关节甚至累及颞叶的侧颅底肿瘤。

Abstract:

Abstract:ObjectiveTo investigate the indications and effect of infratemporal fossa type B approach in the surgical treatment of lateral skull base tumors.MethodsClinical data of 8 patients receiving surgical treatment of lateral skull base tumors via infratemporal fossa type B approach in our department from January 2015 to June 2018 were analyzed retrospectively. The types of the tumors included rhabdomyosarcoma (n=1), muture teratoma (n=1), giant cell tumor of bone (n=1), squamous cell carcinoma of temporal bone (n=1), giant cell reparative granuloma (n=2), cholesteatoma (n=2).ResultsThere were 3 patients whose lesions involved jugular foramen, internal carotid artery and petrous apex. In the other 5 patients, tumors mainly involved zygomatic arch, temporomandibular joint, middle skull base and even temporal lobe. 7 patients underwent surgical removal of tumors via infratemporal fossa type B approach, and one via infratemporal fossa type B combined transcochlear approach. Tumors were removed radically in all 8 patients. After operation, 4 patients suffered from severe conductive hearing loss and the other 4 suffered from severe sensorineural hearing loss. After operation, facial paralysis did not aggravated in 2 patients with preoperative facial paralysis, and 2 of those with preoperative normal facial nerve function developed facial paralysis due to intraoperative facial nerve transfer in the patient with combined approach and resection of tumorinvolved facial nerve in another. During the followup period, no serious complications such as cerebrospinal fluid otorrhea, intracranial hemorrhage, intracranial infection, hemiplegia and death occurred.ConclusionsInfratemporal fossa type B approach has great advantages in exposing the vertical and horizontal segments of internal carotid artery and petrous apex. It can also be used to remove the tumors involved zygomatic arch, temporomandibular joint, middle skull base and even temporal lobe.