추체사대부 병변에 대한 경추체 접근법의 임상경험
Surgical Experiences of Transpetrosal Approach in Petroclival Lesions
소속 상세정보
나형균/Hyung Kyun Rha
이경진/조경근/박성찬/박해관/정동섭/지철/강준기/최창락/Kyung Jin Lee/Kyung Keun Cho/Sung Chan Park/Hae Kwan Park/Dong Sub Chung/Chul Chi/Joon Ki Kang/Chang Rak Choi
KMID : 0359819980270050004
Abstract
서 론
추체 사대부 병변은 수술적 접근이 매우 어렵고 수술 이병율이 높은 질환으로 최근까지
다양한 접근법이 시도되어 왔으나 어느 접근법도 만족한 결과를 보여주지는 못했다.
Morrison과 King등의 경미로 경천막접근법을 응용한 경추체 접근법이 개발된 후 많은 의사
들에 의해서 추체 사대부 병변에 대한 경추체 접근법의 유용성이 발표되었다.
경추체 접근법은 처음에는 주로 소뇌-교각의 거대 청신경종의 수술사 종양에 대한 접근을
보다 쉽게 하기 위해서 시도되었으나 현재는 기저동맥의 노출 및 뇌간전방부의 다양한 병변
등에 대해서 뇌견인을 최소화하면서 병변에 대한 치대한의 노출이 가능한 방법으로 인정받
고 있다. 그러나 이 방법은 병변에의 도달에 많은 시간과 노력이 필요하며 측두골의 해부학
적 지식이 요구되기 때문에 시행에 어려움이 많다 저자들은 최근 5년간 추체 사대부 병변에
대해서 경추체 접근법으로 수술을 시행한 15예의 환자들을 분석하여 병변의 종류, 위치, 크
기 및 침범부위에 따른 수술 접근법의 선택과 수술후 합병증 및 경추체 접근법의 노출범위
등을 연구하였다.
#초록#
This is a report of 15 consecutive cases of petroclival lesions performed by
transpetrosal approach over five years. Pathologies from these cases induce 13 cases of
tumors and two cases of aneurysms. All cases of tumors were over 4.5㎝ in size. Two
cases of very low-lying basilar bifurcation aneurysms and one case of facial schwanoma
extended to the petrosal tip and temporalfossa were operated with anrerior transpetrosal
approach. where as nine cases of petroclival tumor which was localized in the posterior
fossa were operated viapoterior transpetrosal approch. Of these nine cases. One case
withlower clival extension was removed totally by adding a retrosigmoid dural opening.
Remaining three casesextended to the Meckel's cave or cavernous sinus were operated
by combined anteior-posterior transpetrosal approach. Of the 12 cases done with
posterior transpetrosal or combined approach. nine cases with preserved serviceable
hearing were approached by retrolabylinthine technique and remaining three cases
without preservation of serviceable hearing were operated via retrolabylinthine techique.
Total removal wasachieved in 9 of 13 tumor cases. Of two cases, aneursmal neck of the
casewas clipped completely but was clipped together with right posterior cerebral artery
in second case. There was no significantly improved by the time of follow up
examination. Permanent postoperative dysfunction was present in 6 cases. hemiparesis in
2. facial paralysis in 2 and hearing important in 2 cases. These results suggest that
when selecting the surgical approach to the petroclival lesions. the size, location, extent
of the lesion and preperative status of the hearing were important factors to be
considered. We recommend combined anterior-posterior transpetrosal approach for the
complex lesions in the petroclival area which extends into the middle
fossa(Meckel'scavum or cavernous sinus). Also, we recommend combining with
retrosigmoid dural opening or a far lateral type of with brain stem invasion by tumor.
vascular encasement of cavernous sinus invasion without cranial nerve involvement. we
recommend subtotal resection of the tumor and radiosurgery to prevent permanent
postperative sequele.
Petroclival lesions; Transpetrosal approach; Surgical approach; combined approach; Postperative neurological complications.;
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