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Chinese Journal of Neuromedicine ; (12): 690-694, 2016.
Artigo em Chinês | WPRIM | ID: wpr-1034415

RESUMO

Objective To study the microscopic anatomy of the petroclival region through simulated subtemporal transtentorial and transpetrosal presigmoid approaches, and discuss their respective scope for clinical application and provide reference to petroclival region surgical approaches. Methods Ten wet adult head specimens (20 sides) were studied by subtemporal transtentorial and transpetrosal presigmoid approach under microscope, respectively; the features of vessels and nerves of the petroclival area, microanatomic relations of vessels and nerves with their surrounding structures were researched; the exposure scope of these two operative approaches to petroclival region was described. Results The trochlear nerve entered the edge of tentorium in post-lateral posterior clinoid process with a mean distance of (15.72±3.81) mm, and it sneaked (6.82±1.81) mm in the tentorium into the external wall of the cavernous sinus. When the tentorium was cut off, it could expose the posterior clinoid process and posterior communicating artery at upper bound, and petrous ridge at lower bound. The distance from petrous sigmoid sinus junction to the posterior semicircular canal was about (10.48 ±0.42) mm, Trautman's triangle could be exposed about (243.5±26.1) mm2. The rear of the cavernous sinus, Meckel's cavity and saddle back at upper bound, the contralateral slopes at the inside, and the bridge of groove and ventral medulla oblongata at lower bound could be reached via transpetrosal presigmoid approach. Conclusions Subtemporal transtentorial approach mainly applys to the upper, middle parts of slopes and petrous apex lesions;the temporal lobe needs to be lifted in the operation, which may damage Labbe vein. Transpetrosal presigmoid approach can be applied to superior, middle and inferior slope and petrous apex lesions, it has advantage of light pulling brain tissues and wide exposure than subtemporal transtentorial approach; however, intraoperative trauma and long operation time may cause hearing impairment and cerebrospinal fluid leakage.

2.
Artigo em Chinês | WPRIM | ID: wpr-591449

RESUMO

Objective To evaluate the efficacy of double flap reconstruction after craniectomy through transpetrosal-presigmoid approach in the treatment of petroclival tumor.Methods A total of patients with petroclival tumor were enrolled in this study.Craniectomy was performed on them through the transpetrosal-presigmoid approach,and then double flap reconstruction was carried out.After the temporo-occipotal free osseous flap(retrosigmoid flap)was obtained,the superficial flap of the mastoid process(presigmoid flap)was freed by grinding and drilling.During the operation,partial petrosectomy and mastoidectomy were avoided to protect the semicircular canals and cochlea.Results Among the 14 cases,radical resection of the tumor was performed on 8 patients,subtotal resection on 3,and partial resection on 3.Two patients developed CSF leak through the ear.No subcutaneous hydrops or intracranial infection was found in the patients.The patients were followed up at 3 and 6 months after the operation,during which no complications were detected.Conclusions The rates of CSF leak,subcutaneous hydrops,and intracranial infection are low after applying double flap reconstruction to craniectomy through the transpetrosal-presigmoid approach.The procedure are mini-invasive and safety.

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