经耳前颧弓硬膜外人路切除海绵窦肿瘤60例分析  

Resection of cavernous sinus tumor with subtomperal preauricular extradural approach： clinical experience and analysis of 60 cases

作　　者：卜博[1] 周定标[1] 余新光[1] 许百男[1] 张远征[1] 乔广宇[1] 周涛[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华神经外科杂志》2011年第6期676-679,共4页Chinese Journal of Neurosurgery

摘　　要：目的 总结回顾2002年至2009年经治的海绵窦病变60例的临床特点、手术入路及手术效果。方法神经鞘瘤18例，海绵状血管瘤23例，皮样囊肿9例，脑膜瘤4例，脊索瘤3例，垂体瘤3例。均经耳前颧弓硬膜外入路切除。结果神经鞘瘤18均全切，海绵状血管瘤23例，全切18例，5例有残留。皮样囊肿9例全切，脑膜瘤4例，全切3例，次全切1例。脊索瘤3例，结合经鼻蝶窦入路手术，均达到了全切。垂体瘤3例全切。结论经耳前颧弓硬膜外入路切除海绵窦病变是一个理想的手术入路，可以充分显露病变，减少对脑组织的牵拉，也可以明确Ⅲ～Ⅵ脑神经和颈内动脉的位置，减少神经和血管损伤的概率。对与动脉或神经粘连无法彻底切除的病变可以辅以立体定向放射治疗。Objective To review our experience of microsurgery for 60 cavernous sinus tumors from 2002 to 2009. The clinical features, surgical techniques and outcome of cavernous sinus tumor in 60 cases were investigated retrospectively. Methods The patients included 23 hemangiomas, 18 shwannomas, 9 dermoid cysts, 4 meningiomas, 3 chordomas, 3 pituitary adenomas. All the tumors were removed with subtomperal preauricular extradural approach. Results The tumors were removed satisfactorily. The shwannomas were totally removed. The hemangiomas were totally removed in 18, near - totally removed in 5 cases. Nine dermoid cysts were removed totally. For the 4 meningiomas, 3 were removed completely, near - totally removed in 1 cases. The 3 Chordomas were resected near - totally and achieved a completely removal with combined approach. Conclusion The subtomperal preaurieular extradural approach is a rational choice. It can reveal the cranial nerve branches and artery at an early stage so that cranial nerves Ⅲ - Ⅵ and internal carotid artery can be preserved during operation. The tumor exposure is ideal and brain traction and contusion are slightly. The adjunctive radiotherapy is demanded for residual tumors adhering to nerves and arteries severely.

关 键 词：海绵窦肿瘤 硬膜外入路 显微神经外科 

分 类 号：R730.5[医药卫生—肿瘤]