目的总结岩斜区肿瘤3种不同入路优缺点,探讨选择手术入路应考虑的因素,以及如何选择入路,并对临床效果进行分析。方法回顾性分析2004—2014年手术切除岩斜区肿瘤21例临床资料,手术入路包括:枕下乙状窦后入路、乙状窦前入路和颞下经小脑幕入路3种,从肿瘤性质、生长方式、术后并发症和操作难度等因素进行分析,总结选择手术入路时如何依据这些因素对3种入路进行选择,观察依据这些因素指导手术入路选择的临床效果,分析正确选择手术入路对保护神经功能、提高患者生存质量,提高手术效果的作用。结果本组21例,全切16例,次全切4例,部分切除1例。神经鞘瘤6例,表皮样囊肿3例,脑膜瘤12例。术后1例为乙状窦前入路,术后出现脑脊液耳漏,颅内发生化脓性感染,治疗无效死亡;5例出现患侧滑车神经损伤,有复视;6例周围面神经瘫痪;1例出现颞叶脑内血肿,经过保守治疗后,血肿吸收,正常出院;3例出现运动性失语,经治疗后,渐好转;3例出现手术区皮下积液并有反复低热,给予留置腰大池治疗,无临床症状出院,1~2月随访,体温正常,积液消失。5例肿瘤残留术后进行放射治疗,未有复发。结论手术入路所经过的解剖结构不同,暴露范围分别有侧重点,术前应当综合考虑各种因素,选择最适合患者入路,这样可以最大限度保护周围组织,提高手术成功率。 Objective To summarize the advantages and disadvantages of three different approaches in petroclival tumors and to explore the factors that should be considered in the selection of surgical approaches and how to choose the approach and to analyze the clinical effects. Methods The clinical data of 21 patients with petroclival surgery during 2004-2014 were analyzed retrospectively. The surgical approach included three posterior suboccipital sigmoid sinus approaches, the sigmoid anterior approach and the infratentorial tentorial approach, From the aspects of tumor nature, growth pattern, postoperative complications and operation difficulty and other factors, we summarize how to select the three kinds of approaches according to these factors when choosing surgical approach, and observe the clinical effects of these factors guiding surgical approach selection, Analysis of the correct choice of surgical approach to the protection of nerve function, improve patient quality of life, improve the effect of surgery. Results The group of 21 cases, 16 cases of complete removal, subtotal 4 cases, partial resection in 1 case. Schwannoma in 6 cases, epidermoid cyst in 3 cases, meningioma in 12 cases. One patient had sigmoid sinus anterior approach, cerebrospinal fluid otorhism occurred, and intracranial suppurative infection occurred. One patient died of idiopathic trochanteric nerve injury in 5 patients, double vision was performed in 5 patients, paralysis of the facial nerve in 6 patients, and 1 patient There was a temporal lobe intracerebral hematoma, after conservative treatment, hematoma absorption, normal discharge; 3 cases of exercise aphasia, after treatment, gradually improved; 3 cases of subcutaneous effusion and there are repeated low fever surgery, giving lumbar cistern treatment , No clinical symptoms were discharged, 1 to 2 months follow-up, normal body temperature, effusion disappeared. Five cases of residual tumor after radiotherapy, no recurrence. Conclusion There are different anatomical structures in the surgical approach and the scope of the exposure are different. All kinds of factors should be considered before the operation, and the most suitable approach for the patients is selected. This can maximize the surrounding tissue and improve the success rate of the operation.