1、改良Kawase入路切除岩斜区脑膜瘤 后颅窝脑膜瘤约占脑膜瘤的10%，其中岩斜脑膜瘤约占11%。其中女性多见，女：男约为2：1；发病年龄多为中年。Small 4.5cm I.一侧颅神经功能障碍，累及第3-10颅 神经II.同侧小脑体征III.锥体束征 IV.颅高压症状A.脑干面可能粘连紧密B.包裹多支颅神经C.包绕基底动脉及分支D.需要充分颅底部显露经岩骨乙状窦前入路颞下经岩骨前路入路-Kawase入路（1）枕下乙状窦后入路联合入路*1.Kawase T,Shiobara R,Toya S(1991)Anterior transpetrosaltranstentorial approach f
2、or sphenopetroclival meningiomas:surgical method and results in 10 patients.Neurosurgery 28:869875p需要长时间颅底实验室训练p脑膜与岩鳞缝粘连紧密，剥离损伤岩浅大神经致面瘫p术后硬膜外渗血p术后脑脊液漏p术中需另行切口采取脂肪组织填塞岩骨缺损 以三叉神经压迹（以三叉神经压迹（TITI）、岩骨嵴（）、岩骨嵴（PEPRPEPR）为标记）为标记三叉神经压迹向侧方（三叉神经压迹向侧方（A A）不超过）不超过1.5cm1.5cm向岩骨嵴方向（向岩骨嵴方向（B B）不超过）不超过6mm6mm岩骨表面向下深度不
3、超过岩骨表面向下深度不超过8mm8mm姓名：夏某性别：女年龄：55岁职业：农民地址：绍兴嵊州病案号：793882入院诊断：1.左侧继发性三叉神经痛 左侧岩尖部及桥小脑角脑膜瘤 2.高血压病姓名：虞某性别：女年龄：54岁职业：农民地址：湖州德清病案号：791518入院诊断：1.左侧桥小脑角占位：脑膜瘤？2.高血压病姓名：杨某性别：女年龄：58岁职业：退休地址：连云港灌南病案号：810487姓名：胡某性别：女年龄：69岁职业：退休地址：宁波江北病案号：825457自颧弓下0.5cm，沿耳屏前方2cm处弧形向后上方延伸10-11cm保留颞浅筋膜，近颞下颌关节处切开，以保留面神经额颞支T型切开颞浅筋膜
4、，便于牵开以暴露术野肌肉呈纵行切开肌肉需要有角度的牵开，以利于暴露颧弓根部及中颅窝底，在此上方0.5cm处钻孔。游离骨瓣约46cm，下缘以外耳道为中心20%甘露醇250ml，过度换气，腰大池引流适合适合IACIAC内上方岩斜区肿瘤内上方岩斜区肿瘤根据需要有选择的切除岩尖骨质根据需要有选择的切除岩尖骨质降低术后降低术后CSFCSF漏及颞肌萎缩的风险漏及颞肌萎缩的风险无需再次手术取脂肪无需再次手术取脂肪1.1.过早的硬膜下操作易造成颞叶挫伤过早的硬膜下操作易造成颞叶挫伤2.2.操作增加了损伤颞叶引流静脉的风险，术操作增加了损伤颞叶引流静脉的风险，术前需释放脑脊液（或予甘露醇、气道压控制）前需释放脑
5、脊液（或予甘露醇、气道压控制）以获得更好的术野暴露以获得更好的术野暴露3.3.术前术前MRVMRV提示颞叶在颅底有粗大的引流静提示颞叶在颅底有粗大的引流静脉，建议行枕下乙状窦后入路脉，建议行枕下乙状窦后入路“Many factors that prevent GTR are Many factors that prevent GTR are independent independent of the of the particular surgical approach chosen or even of the surgical skill particular surgical appr
6、oach chosen or even of the surgical skill or experience of the treatment team.These factors include or experience of the treatment team.These factors include cavernous sinus invasioncavernous sinus invasion,brainstem pial invasionbrainstem pial invasion,neuro-vascular structures encasementneuro-vasc
7、ular structures encasement,and,and firm tumor firm tumor consistencyconsistency.”.”*Little KM,Friedman AH,Sampson JH,Wanibuchi M,Fuku-shima T:Surgical management of petroclival meningiomas:defining resection goals based on risk of neurological morbid-ity and tumor recurrence rates in 137 patients.Neurosurgery 56:546559,2005
