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目的探讨电生理监测下耳前锁孔颞下入路显微手术治疗岩斜区肿瘤的手术技巧和治疗效果。方法根据肿瘤术前影像学特点,采用耳前锁孔颞下入路切除肿瘤,术中辅以神经电生理监测。结果本组共18例患者,其中15例肿瘤全切除(83.3%),2例次全切除(11.1%),1例大部切除(5.6%)。术后出现动眼神经麻痹1例,术后9 d出院时已恢复;复视2例,其中1例4个月后恢复,1例6个月后复查明显缓解;面部感觉减退3例,1例2个月后基本缓解,2例6个月后恢复;面瘫1例,6个月后痊愈;无脑脊液漏、偏瘫、失语及死亡病例。结论耳前锁孔颞下入路显微手术是治疗主要位于中、上斜坡的岩斜区肿瘤的理想选择,术中神经电生理监测有助于保护神经功能,减少神经功能损害。
Objective To investigate the surgical techniques and therapeutic effects of microsurgical treatment of petroclival tumors by electrophysiological monitoring of anterior keyhole approach. Methods According to the preoperative imaging features of the tumor, the tumor was treated by the subfornical approach to the inferior temporal earhole. The intraoperative electrophysiological monitoring was used. Results The group of 18 patients, including 15 cases of total resection of the tumor (83.3%), 2 cases of subtotal resection (11.1%), 1 case of subtotal resection (5.6%). One patient had oculomotor nerve paralysis after operation, and recovered at 9 d after operation. Two patients underwent diplopia, of which 1 patient recovered after 4 months and 1 patient recovered significantly after 6 months. Facial sensation decreased in 3 patients and 1 The cases were basically relieved after 2 months, 2 cases recovered after 6 months, 1 case had facial paralysis and recovered after 6 months. No cerebrospinal fluid leakage, hemiplegia, aphasia and death were found. Conclusion The microsurgical treatment of the inferior anterior keyhole and inferior temporal approach is an ideal choice for the treatment of petroclival tumors mainly in the middle and upper slopes. Electrophysiological monitoring during operation helps to protect the neurological function and reduce neurological damage.