岩骨尖区巨大哑铃型三叉神经鞘瘤的诊断及治疗  

Diagnosis and Treatment of Gaint Dumbbell Trigeminal Neurinoma

作　　者：贾桂军[1] 张俊廷[1] 吴震[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科

出　　处：《首都医科大学学报》2005年第4期400-402,共3页Journal of Capital Medical University

摘　　要：目的探讨巨大岩骨尖三叉神经鞘瘤的特点和治疗方法.方法分析35例巨大岩骨尖三叉神经鞘瘤患者临床特点、影像学表现,所有病例均行显微外科手术切除肿瘤,其中经硬脑膜下颞底入路28例,额眶颧入路5例,颞枕-枕下联合入路2例.结果肿瘤全切除33例,全切除率为94.3%;因肿瘤与重要结构粘连导致全切除困难而次全切除2例.无手术死亡.病理:神经鞘瘤34例,间变性神经鞘瘤1例.手术后新的神经功能损害包括:动眼神经不完全性麻痹4例,手术后2月内恢复;外展神经麻痹8例,4例随访时恢复;术后轻度偏瘫1例,3周后恢复.所有病例原有神经功能障碍无加重.随访18例(随访率51.4%),随访时间3月～5年,全切除病例肿瘤无复发;次全切除病例1例失访,另1例随访2年未见肿瘤生长.结论巨大哑铃型三叉神经鞘瘤有其影像学特点,个体化的手术入路对减少损伤,充分暴露肿瘤有重要意义,多数病例预后良好.Objective To study the diagnosis and microneurosurgical treatment of gaint dumbbell trigeminal neurinoma. Methods 35 cases of dumbbell trigeminal neurinoma which had been diagnosed by MRI were operated through microsurgery. 28 cases were through the subtemporal transtentorial approach. 5 cases were through the frontotemporal with zygomatic osteotomy approach, 2 cases received operation through retrosigmoid approach. Results Total resection was achieved in 33 cases（94.3 % ）, subtotal resection in 2 cases. No operative death. Their pathohistological diagnosis were neurinoma. The symptoms before operation such as headache was improved. The abducence nerve palsy was occurred in 8 cases postoperativly, 4 cases was recovered at least. There was no perminant disfunction of the oculomotor nerve. The patients with hydrocephalus were improved after operation. The follow-up period was between 3- 60 months, and the follow up rate was 51.4 %. The cases of total resection were no recurrences. The case of subtotal resection was stable after γ-knife treatment. Conclusion The gaint dumbbell trigeminal meurinoma shows its characters of MRI. The approprite individual approach and a good exposure during operation are very important.

关 键 词：三又神经鞘瘤 显微神经外科 入路 

分 类 号：R739.41[医药卫生—肿瘤]