颈静脉孔区肿瘤的显微外科治疗  

Microsurgical treatment jugular foramen tumors

作　　者：石忠松[1] 黄正松[1] 陈晓雷[1] 黄权[1] 刘金龙[1] 吴新建[1] 林佳平[1] 夏之柏[1] 金华伟[1] 齐铁伟[1] 

机构地区：[1]中山大学附属第一医院神经外科,广州市510080

出　　处：《中华显微外科杂志》2005年第2期103-105,i001,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨颈静脉孔区肿瘤显微手术的临床疗效。方法分析近4年采用显微外科技术治疗颈静脉孔区肿瘤10例的临床资料,主要临床表现为听力下降和后组脑神经损害,术前行头颅核磁共振和颅底薄层CT扫描,8例行数字减影脑血管造影检查。采用显微外科手术切除,其中经颈静脉孔入路6例,远外侧入路2例,枕下乙状窦后入路2例。结果10例术中肿瘤全切除9例,次全切除1例。病理学示神经鞘瘤6例,神经纤维瘤1例,脑膜瘤1例,转移瘤1例,颅咽管瘤1例。术后2例完全清醒后末及时行气管切开术而突发喉头水肿窒息死亡。存活8例磁共振复查显示肿瘤全切除7例,次全切除1例。8例术后症状改善3例,症状不变3例,症状加重2例。结论采用显微外科技术选择适当的手术入路可以较好地切除颈静脉孔区的肿瘤,经颈静脉孔入路可能是该区域肿瘤手术治疗的最佳入路。Objective To evaluate the microsurgical techniques and outcomes of jugular foramen tumor. Methods From April 2000 to June 2004, we treated 10 patients of jugular foramen tumor. The common clinical presentation were hearing difficulty and involvement of cranial nerves Ⅸ,Ⅹ, Ⅺ. All patients had been detected by MRI and CT scan of skull base and 8 cases underwent cerebral angiography. 10 cases of tumor were removed using microsurgical techniques. Transjugular (craniocervical) approachs were used in 6 cases, far lateral approachs were used in 2 cases, and retrosigmoid suboccipital approach were used in 2 cases. Results There were total removal tumor in 9 cases, subtotal removal in 1 case. 10 cases were conscious from operation, but 2 cases died of sudden laryngeal edema. There were improvement from preoperative symptoms in 3 cases, no change 3 cases, additional deficts 2 cases. Follow-up of post-operative MRI in 8 cases revealed total removal tumor in 7 cases and subtotal removal in 1 case. Conclusion Jugular foramen tumor can be surgically removed with suitable skill and gained satisfactory outcomes. Transjugular approach maybe the best approach for jugular foramen tumor resection.

关 键 词：颈静脉孔区肿瘤 显微外科治疗 经颈静脉孔入路 枕下乙状窦后入路 脑血管造影检查 肿瘤全切除 薄层CT扫描 头颅核磁共振 主要临床表现 显微外科技术 外科手术切除 行气管切开术 次全切除 脑神经损害 远外侧入路 神经纤维瘤 

分 类 号：R739.91[医药卫生—肿瘤] R739.42[医药卫生—临床医学]