经卵圆孔穿刺海绵窦肿瘤活检（附二例报道）  

Percutaneous biopsy of cavernous sinus tumor via the foramen ovale： a report of 2 cases

作　　者：易伟[1] A Tommy Bergenheim 

机构地区：[1]武汉大学人民医院神经外科,武汉430060 [2]瑞典Umea大学医院神经外科,SE一90187

出　　处：《中华神经医学杂志》2010年第8期806-808,共3页Chinese Journal of Neuromedicine

摘　　要：目的 介绍一种不经颅获得海绵窦肿瘤活检的方法 . 方法 选择2例影像学诊断为海绵窦占位性病变的患者,例1 MRI示左中颅窝中线附近强化明显的肿块;例2 MRI示左侧海绵窦区明显强化的病变.2例患者术前均行头颅MR扫描和三维重建,计划穿刺线路,在X线引导下使用Hartel入路（即从口角外侧2.5～3.0 cm进针,针的方向指向卵圆孔）穿刺卵圆孔,刺入卵圆孔后继续进针约15～18 mm,然后送CT室行头颅CT增强扫描,证实穿刺针进入肿瘤实质后,抽吸肿瘤组织行快速冰冻切片和常规病理切片检查. 结果 2例患者肿瘤组织活检均获成功,术后无并发症.1例确诊为脊索瘤,1例确诊为脑膜瘤. 结论 经卵圆孔穿刺活检是一个简便、安全、有效的获得海绵窦占位病理诊断的方法 .Objective To introduce a non-transcranial biopsy approach for tumours involving the cavernous sinus. Methods A technique of image-guided percutaneous biopsy through the oval foramen was performed in 2 patients with cavernous sinus tumours. In patient 1, the head MRI scan demonstrated an invasive sphenoid tumour locating in the middle cranial fossa base. In patient 2, the head MRI scan showed a contrast enhancing lesion confined to the left cavernous sinus area. Both patients were re-scanned by a head MRI and the images were reformatted and aligned. And the intended trajectory of the biopsy needle through the foramen ovale was designed. By using the Hartel approach （at the point of 2.5-3.0 cm lateral to the comer of the mouth and towards the foramen ovale） with the aid of fluoroscopy, the biopsy needle was introduced into the oval foramen. After penetrating the foramen ovale,the needle was further advanced approximately 15-18 mm until reaching the level of the clivus. With confirmation of position of the needle by a contrast enhanced CT scanning, the tumour samples were obtained, following by a frozen section and a paraffin section examination. Results The procedures were successfully performed without complications in the 2 patients. One had a chordoma and another had a meningioma. Conclusion Percutaneous biopsy via the foramen ovale is a safe and conclusive method to obtain histopathological diagnoses.

关 键 词：海绵窦 脑膜瘤 脊索瘤 卵圆孔 活组织检查 针吸 

分 类 号：R739.4[医药卫生—肿瘤]