岩骨次全切除术在侧颅底病变治疗中的应用

Application of subtotal petrosectomy for lesions of lateral skull base

摘要:

目的 探讨岩骨次全切除术应用于多种侧颅底病变的治疗效果。方法 回顾性分析2007年7月—2019年9月行岩骨次全切除术的78例患者的临床资料，男40例，女38例；平均年龄(37.3±14.1)岁。其中岩骨胆脂瘤28例，慢性中耳炎术后感染20例，颞骨良性肿瘤19例，脑脊液耳漏11例。术前患者均行纯音测听、颞骨CT、内耳MRI，面神经功能评价House-Brackmann分级：Ⅰ级25例，Ⅱ级19例，Ⅲ级15例，Ⅳ级10例，Ⅴ级5例，Ⅵ级4例；全聋21例，余者平均听力52.2 dB。术后复查颞骨CT、内耳MRI并评价面神经功能。结果 平均随访5.51年，术后无死亡、颅内出血、脑脊液耳漏等严重并发症。岩骨胆脂瘤、慢性中耳炎术后感染患者术后复发各2例，经再次手术治愈；颞骨良性肿瘤均完全切除肿瘤，其中14例面神经鞘瘤患者中9例行面神经-舌下神经吻合术。术后面神经功能评价：Ⅰ级28例，Ⅱ级20例，Ⅲ级17例，Ⅳ级7例，Ⅴ级2例,Ⅵ级4例；所有患者均无实用听力。结论 岩骨次全切除术适用于广泛的岩骨胆脂瘤、慢性中耳炎术后感染及颞骨良性肿瘤的切除，也可用于防治脑脊液耳漏；此术式无法保留或重建听力，故仅适用于无听力重建条件者。

关键词:岩骨次全切除术;面神经功能;脑脊液耳漏

Abstract:

Objective To analyze the clinical effect of subtotal petrosectomy for lesions of lateral skull base.Methods Clinical data of 78 patients who received subtotal petrosectomy from July 2007 to September 2019 were retrospectively analyzed. The 78 patients included 40 males and 38 females, with an average age of (37.3±14.1) years. Among them, there were 28 cases of petrous bone cholesteatoma, 20 of postoperative reinfection of chronic otitis media, 19 of temporal benign tumor and 11 of cerebrospinal fluid otorrhea. All patients underwent preoperative pure tone audiometry, computed tomography (CT) of temporal bone, magnetic resonance imaging (MRI) of inner ear and facial nerve function evaluation. Preoperative facial nerve function according to House-Brackmann (HB) grading system revealed grade Ⅰ in 25 cases, grade Ⅱ in 19, grade Ⅲ in 15, grade Ⅳ in 10, grade Ⅴ in 5, and grade Ⅵ in 4. There were 21 cases of total deafness on the affected side before operation, and the average hearing threshold of the other patients was 52.2 dB. During postoperative follow-up visit, CT of temporal bone and MRI of inner ear were performed and the function of facial nerve was evaluated.Results All the patients had been followed up for an average of 5.51 years. Surgical treatment was successfully performed in all the 78 patients, and there were no deaths and no severe complications such as intracranial hemorrhage, or cerebrospinal fluid otorrhea. Postoperative recurrence ocurred in 2 patients with petrous bone cholesteatoma and 2 with chronic otitis media reinfection, and got cured by reoperation. All the 19 patients with temporal benign tumors underwent total resection, and 9 of the 14 patients with facial schwannoma underwent facial nerve-hypoglossal nerve anastomosis. Postoperative evaluation of facial nerve function showed grade Ⅰ in 28 cases, grade Ⅱ in 20, grade Ⅲ in 17, grade Ⅳ in 7, grade Ⅴ in 2 and grade Ⅵ in 4. In all patients, functional hearing on the affected side was not retained after surgery.Conclusion Subtotal petrosectomy is suitable for extensive resection of petrous bone cholestatoma, chronic otitis media reinfection and temporal benign tumors, and it can also be used to repair and prevent cerebrospinal fluid otorrhea. Since this procedure cannot preserve or reconstruct hearing, it can only apply to patients with extensive skull base lesions without conditions for hearing reconstruction.

Key words:Subtotal petrosectomy;Facial nerve function;Cerebrospinal fluid otorrhea