摘要 目的：介绍并讨论一种处理斜坡及斜坡旁区肿瘤及血管病变经岩骨手术入路。方法：对28例病人实施了乙状窦前-迷路后经岩骨幕上下联合入路手术。结果：显微镜下肿瘤全切率82%，3例桥脑内海绵状血管瘤全部切除，3例基底动脉瘤均成功夹闭。术后4例出现暂时性颅神经损伤症状，1例出现永久性动眼神经损伤症状。颅神经损伤发生率为18%。2例术后脑脊液漏，2例术后死亡，其余病人恢复良好并均保留了听力。结论：该手术入路的主要优点：对小脑及颞叶牵拉轻；可缩短到达斜坡的距离，并对斜坡区提供良好的暴露，可以保留耳蜗、面神经、横窦、乙状窦及Labbe静脉等重要结构。

Abstract Objective: To discribe and discuss a transpetrosal approach fortumorous and vascular lesions of clivus and juxta-clival region. Methods: 28 patients havebeen operated on with the combined supra-and infratentorial presigmoid retrolabyrinthinetranspetrosal approach. Results: 18/22(82%) tumors and 3/3 pontine cavernomas have beentotally removed microsurgically with this approach. In all three patients with basilartrank artery aneurysm complete surgical occlusion of the aneurysm via the transpetrosalroute was achieved. In one patient persisted paresis of the oculomotor nerve and in 4patients transient paresis of the other cranial nerves occurred postoperatively. The rateof the cranial nerve injure was 18% postoperatively. CSF leaks were uncommon, occuring in2 patients. Two patients died during the immediate postoperative period leading to anoperative mortality of 7%. In none of the other patients new neurological deficitsdeveloped and all of the other patients made a good recovery with preservation of hearing.Conclusions: The advantages were offered by this approach such as the cerebellum andtemporal lobes are minimally retracted; the operative distance to the clivus in shortenedwith exposure of clivus and juxta-clival region; the neural and otologic structures,including the cochlea, labyrinth, facial nerve, transverse and sigmoid sinus as well asLabbe's vein can be preserved.

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