CT骨窗位神经导航颞下经小脑幕入路切除上中-第三军医大学学报.docVIP

CT骨窗位导航经颞下入路切除岩斜区肿瘤的临床研究吕安康,钟 东,夏海坚,唐文渊,孙晓川,谭 云,王 兵,石 爽(400016重庆,重庆医科大学附属第一医院神经外科) [摘要]目的：探讨CT骨窗位神经导航对颞下经小脑幕入路切除岩斜区肿瘤的临床意义。方法：对比分析重庆医科大学附属第一医院神经外科自2008年6月至2013年6月16例未使用神经导航和27例使用骨窗位神经导航的岩斜区肿瘤患者均采用颞下经小脑幕入路对肿瘤进行切除的临床手术资料。结果：未导航组16例患者中,术中2例出现乙状窦损伤，术后2例出现颅内感染，1例出现皮下积液；术后随访3～5年，无复发及死亡病例。导航组27例患者中,术后4例出现颅内感染，经济及抗感染治疗后好转，2例出现皮下积液，予弹力绷带持续加压包扎后逐渐吸收；术后随访1～3年，无复发及死亡病例。未导航组16例患者肿瘤全切除率为37.5%(6例)，次全切除率为50.0%(8例)，大部切除率为12.5%(2例)；导航组27例患者肿瘤全切除率为59.3%(16例)，次全切除率为37.0%(10例)，大部切除率为3.7%(1例)。对两种手术方式肿瘤全切除率比较有统计学差异(P＜0.05)。结论：CT骨窗位神经导航定位精确，术中实时导航，有助于最大程度安全磨除岩骨，安全增加暴露，减少乙状窦、骨性半规管及神经组织等损伤，改善患者预后。 [关键词] CT骨窗位；神经导航；颞下经小脑幕入路；岩斜区肿瘤 The Clinical Research of the Resection of the Tumor in Petroclival Region Through Subtemporal tanstentorial Approach under CT Bone Window Neuronavigation Lu Ankang, ZhongDong Xia Haijian, Tang Wenyuan, SunXiaochuan，Tan Yun, Wang Bing, Shi Shuang （Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China） Abstract] Objective: To investigate the clinical significance of subtemporal transtentorial approach under CT bone window neuronavigation to excising the tumor in petroclival region. Methods: Compare 16 patients without using navigation system to 27 patients using navigation system in our department from June 2008 to June 2013, excising the tumor in petroclival region by subtemporal transtentorial approach. Results: Among the 16 patients using navigation system, 6 patients underwent total tumorectomy under microscope, 8 subtotal tumorectomy and 2 partial tumorectomy. Among the 27 patients, 16 patients underwent total tumorectomy under microscope, 10 subtotal tumorectomy and 1 partial tumorectomy. Conclusions: The positioning of CT bone window neuronavigation is accurate. Intraoperative real-time navigation helps to maximize the safe abrasion of the petrous bone, increase the exposure range safely, and reduce injuries of the sigmoid sinus, bony semicircular canal and neurological functions, leading to improv