三例颈静脉孔脊索瘤的诊断和治疗  

Diagnosis and treatment of chordoma in the jugular foramen area： three cases report

作　　者：黄琦[1] 吴皓[1] 汪照炎[1] 杨军[1] 陈立[1] 贾欢[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,200092

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第8期577-581,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨颈静脉孔区脊索瘤早期诊断和手术治疗方法。方法回顾性分析3例颈静脉孔区脊索瘤患者的临床资料，复习有关文献。3例患者均以面神经麻痹为首发症状，面肌变性〉90％。采用颞下窝径路肿瘤切除术1例，岩枕径路肿瘤切除术2例。术中未行面神经修复1例，取游离耳大神经面神经桥接术1例，面-舌下神经吻合术1例。结果3例患者均为肿瘤一次性全切除，经6个月至1年随访，均无复发，2例行面神经修复的患者面神经功能按House—Brackmann分级评估：1例Ⅲ级，1例Ⅳ级，均未出现其他并发症。结论颈静脉孔脊索瘤临床表现复杂，影像学检查可以为早期诊断提供重要参考，确诊尚需术后病理检查。应根据病变部位及肿瘤大小选择手术径路。经典的颞下窝径路可充分暴露视野、达到肿瘤全切除的目的。Objective To discuss the early diagnosis and the treatment of chordoma in the jugular foramen area. Methods Three cases of chordoma in the jugular foramen area were diagnosis and reviewed retrospectively, The initial symptom was facial paralysis. Surgical removal was performed through the infratemporal fossa approach in 1 case, through petro-occipital approach in 2 cases. For repairing facial nerve defect, great auricular nerve was used in 1 case and facial-hypeglossal anastomosis was used in another 2 cases. Results The tumor were totally removed in all 3 cases. The patients were follow-up for 6 months to 1 year and no recurrence was found. The function of facial nerve was Ⅲ grade （House-Brackmann） in one patient and Ⅳ grade in another 2 patients. No complications occurred in 3 cases. Conclusions Although chordoma originating from the jugular foramen area were extremely rare, it was possible to make early diagnosis through finding clinical feature and imaging methods. The final diagnosis depended on pathology. Generally, the different surgical approaches were used according to the size and position of the tumor. The classic infratemporal fossa approach for tumor removal and facial nerve reconstruction should be considered in the patients with chordoma around jugular foramen.

关 键 词：脊索瘤 颈静脉球 耳外科手术 颅底肿瘤 

分 类 号：R686[医药卫生—骨科学]