前外侧或外侧硬脑膜外入路切除海绵窦区肿瘤:附9例临床经验  

Anteriolateral or Lateral Epidural Approach to Resect Tumors in Cavernous Sinus Region:Report of 9 Cases

作　　者：陶存山[1] 楼美清[2] 卢亦成[2] 汪亮[1] 王冰心[1] 李文[1] 张康[1] 蒋建华[1] 

机构地区：[1]江苏镇江解放军第三五九医院神经外科,江苏镇江212001 [2]上海市第二军医大学附属长征医院神经外科,上海200003

出　　处：《中国神经肿瘤杂志》2005年第2期128-131,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:目前对海绵窦区肿瘤的手术治疗仍是神经外科的难题之一。本文旨在提高海绵窦区肿瘤的全切率,降低神经功能的残障率。方法:针对海绵窦外侧壁的显微解剖特点,结合典型病例分析,回顾性总结了9例海绵窦内肿瘤,经前外侧或外侧硬膜外入路,通过显微神经外科技术切开海绵窦外侧壁夹层,按神经走行方向切开,辨认肿瘤生长和颅神经的关系分块切除肿瘤。结果:9例海绵窦内肿瘤中,海绵状血管瘤1例,神经鞘瘤6例,脑膜瘤2例。全切除5例,3例次全切除,1例大部分切除。3例出现新的颅神经功能障碍症状,6个月后新出现的颅神经功能障碍症状减轻2例,完全恢复1例。结论:明确的海绵窦区显微外科解剖概念,娴熟的显微神经外科技术以及选择适当的手术入路是提高海绵窦区肿瘤的全切率,降低术中出血、术后残障率的关键因素。BACKGROUND ＆ OBJECTIVE： Operation on tumors of cavernous sinus region is still one of the most difficult neurosurgical operations. This paper aims to review methods to improve total removal rate of cavernous sinus tumors and how to reduce neurological disability. METHODS： In this regard we studied the anatomic characteristics of the lateral wall of the cavernous sinus and analysis of typical case. We retrospectively summarize the surgical technique and outcome of 9 cases with tumor in cavernous sinus removed by epidural surgical approaches. The epidural approaches including lateral or anterior-lateral surgical approaches, splitting the potential interim of lateral wall of cavernous sinus through microneurosurgical technique. Incision was made parallel to nerve direction. The relationship of tumors and cranial nerve were positively identified before the tumors we reremoved piece by piece. RESULTS：Cavernous sinus is hexahedral structure, its lateral wall consists of two layers, the deep and the superficial layers. Between them are several cranial nerves. Of the 9 cases with tumors seated in cavernous sinus, there are 1 cases cavernous hemangioma, 6 cases schwannoma and 2 cases meningioma pathologically. They were removed by epidural surgical approaches, 5 out of 9cases were total removed, 3 out of 9 cases were subtotal removed. 1 out of 9 cases was partial removed. Whereas 3 out of 9 cases found nes symptoms in cranial nerve,and both of them were recovered 6 months later. CONCLUSIONS： Clear understanding of microsurgieal anatomy of the cavernous sinus.skilled microneurnsurgical technique and careful choice of appropriate surgical approach are key points to total tumor removed with less neurological disabilities.

关 键 词：海绵窦 肿瘤 手术 显微解剖 

分 类 号：R739.41[医药卫生—肿瘤]