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2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。

目的：提高对后颅凹脑膜瘤诊断与治疗的认识。方法：对1987～1993 年收治、显微手术切除的45例后颅凹脑膜瘤病例进行回顾性分析。结果：肿瘤全切29 例（29/45）。疗效：优27例（27/45），良8例（8/45），差5例（5/45),死亡5例（5/45）。结论：术前精确的诊断对手术及预后非常重要。手术入路主要取决于肿瘤的位置、延伸和大小。统计学分析表明病人的预后与术前ASA（美国麻醉学会评分法）级别和术前神经功能状况有关。

本文分析了147列出血性脑血管病，其中自发性脑出血80例，颅内动脉瘤21例，颅内动青脉畸形32例，自发性蛛网膜下腔出血14例。病人术前间状况、有无脑病及血肿大小对判断高血压性脑出血病人的预后有显著作用。并对与颅内动脉瘤及动静脉畸形手术有关的问题作了讨论。

The extremely complex anatomic relationships among bone, tumor, blood vessels and cranial nerves remains a big challenge for cranial base tumor surgery. Therefore, a good understanding of the patient specific anatomy and a preoperative planning are helpful and crucial for the neurosurgeons. Three dimensional (3-D) visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.1 We used the Destroscope Virtual Reality (VR) System (Singapore, Volume Interaction Pte Ltd, software: RadioDexterTM 1.0) to optimize preoperative plan in the complex cranial base tumors. This system uses patient-specific, coregistered, fused radiology data sets that may be viewed stereoscopically and can be manipulated in a virtual reality environment. This article describes our experience with the Destroscope VR system in preoperative surgical planning and simulation for 5 patients with complex cranial base tumors and evaluates the clinical usefulness of this system.

In this retrospective study, the results of surgery were examined in 25 patients, 65 years of age or older, suffcring from malignant tumour growth along the cervical spine. The group consisted of 17 men and 8 women. The mean age was 73 years, ranging from 66go 88 years. The pathology identified was medtastasis in 23 patients, and plasmocytoma in two. The tumour localization involved a single segment of the cervical spine in 12 patients, two segments in 8 pa-tients. three scgments in 4 patients, and four segments in one patient. Pre-operatively, 8 patients (32%) suffered solely from severe pain. 6 patients (24%) showed severe pain and radicular nerve compres-tion. 5 patients (20%) had incomplete parta or tetraparesis but were able to walk, and again 6 paticnts (24%) had incomplete para of tetraparesis, and were unable to wald. A multitude of accompanying systemic diseases was present in the majority of patients. Evaluation of the pcri-operative risk profile was parformed using the American Socicty of Anaesthesiology (ASA) Grading of Physical Status Score. Operation consisted of microsurgical tumour removal, usually in-corporationg a single or multi-level vertebrectomy, with radical epi-dural decompression, and grafting with bone cement followed by an ippropriate osteosynthesis. Of the whole cohort of patients treated, four patients were till alive at the time of the last follow-up evaluation. 21 patients did. Four patients died within seven days after surgery. The remaining 17 patients died during the follow-up period. All of these patients died from systemic spread of their primary cancer. The results of mrgery in terms of postoperative neurological outcome were as Fol-lows: 11 patients or 44% were improved by surgery. 7 patients (28%) were unchanged, three patients (12%) became worse, and four pa-tents (16%) died. With regard to functional outcome, 73% of the patients with severe pre-operative neurological deficits showed sig-inficant postoperative amelioration of symptoms. 19 patients became imbulatory until the final sage of their disease. It is concluded, that according to the results of this limited study, general nihilistic or purely conservative approach for the treatment of elderly patients suffering from secondary malignancy of the cer-vical spine is not justified. With proper patient sclection, aggressive mrgery leads to significant amelioration of pre-operatively existing neurological deficits and long-term ambulation in a considerable percentage of the patients.