颅颈部远外侧入路显微切除颈静脉孔区肿瘤  

Application of far lateral craniocervical approach in the microsurgical treatment of the jugular foramen tumors

作　　者：吴波[1] 刘卫东[1] 陈隆益[1] 黄光富[1] 

机构地区：[1]四川省人民医院神经外科,成都610072

出　　处：《中华外科杂志》2013年第1期49-53,共5页Chinese Journal of Surgery

摘　　要：目的探讨颅颈部远外侧入路在显微手术切除颈静脉孔区肿瘤中的应用。方法回顾总结2009年1月至2012年1月经远外侧入路切除颈静脉孔区肿瘤的14例患者临床资料，包括神经鞘瘤9例、脑膜瘤3例、颈静脉球瘤1例、腺样囊性癌1例，6例并发脑积水。肿瘤分型：I型（颅内．孔内型）5例，Ⅱ型（颅内一颈椎管型）1例，Ⅲ型（颅外-孔内型）4例，Ⅳ型（颅内外沟通哑铃型）4例。手术采用远外侧枕髁后（FLPC）入路2例，远外侧经颈静脉突（FLTJP）入路3例，FLPC＋经C。椎板入路1例，FLTJP＋经c．横突入路7例，FLTJP＋颈部经颈动脉鞘入路1例。1例颈静脉球瘤术前栓塞。结果肿瘤全切除12例，次全切除2例，无患者出现术后脑脊液漏及死亡。患者术后随访5～32个月，平均13．7个月。术后新发面瘫1例，部分恢复；新发吞咽困难、声音嘶哑及呼吸困难1例，与6例术前即有后组脑神经损害症状患者均逐渐恢复，吞咽功能正常或接近正常，4例仍存在声音嘶哑；但1例术前有后组脑神经损害症状的腺样囊性癌患者无恢复。6例患者术前并发脑积水均趋于消退。肿瘤全切除者无复发，次全切除者无进展。结论FLTJP入路是处理颈静脉孑L区病变的基本入路，根据肿瘤向咽旁间隙或颈椎管扩展范围可联合颈部入路，脑积水通常无需额外手术处理。Objective To investigate the administration of far lateral craniocervical approach in the jugular foramen （JF） tumors. Methods A retrospective analysis was performed in 14 cases of JF tumors （9 neurilemmomas, 3 meningiomas, 1 glomus jugulare tumor, and 1 adenoid cystic carcinoma） surgically treated between January 2009 and January 2012, with focus on the surgical approach. Six patients （6/14） showed hydrocephalus. The tumor type was composed of 5 intracranial and intraforamen tumors with patent or occluded jugular bulb, 1 intracranial tumor with extension into the upper cervical canal, 4 extracranial and intra foramen tumors, 4 intra- and extracranial dumbbell-shaped communicating tumors involving the parapharyngeal space above C2 or extending caudally below C3. Far lateral postcondylar approach （FLPC） was carried out in 2 cases, far lateral tansjugular process approach （FLTJP） in 3 cases, combined FLPC ＋ C1-2 semi-lamineetomy approach in 1 case, combined FLTJP ＋ trans-C1 transverse process approach in 7 cases, and combined FLTJP ＋ neck approach with dissection of carotid sheath to the skull base in 1 case. Endovascular embolotherapy prior to surgical resection was performed in 1 glomus jugulare tumor. Results Total tumor removal was achieved in 12 patients and subtotal removal in 2 patients, with no cerebrospinal fluid leakage or operative mortality. New cranial nerve paresis occurred after surgery in 1 case of facial nerve and 1 case of lower cranial nerve. Transient worsening of preoperative lower cranial nerve deficits was noted in 3 patients. Long-term follow-up study ranging from 5 to 32 months （average 13.7 months ） showed 7 patients with lower cranial nerve deficits （6 preexisting and 1 new） , with exception of one preoperative lower cranial nerve dysfunction due to the infiltration of an adenoid cystic carcinoma, experienced favorable improvement with recovery of adequate swallowing function, but voice disturbance remained in 4 cases. One patient with new facial nerve de

关 键 词：脑肿瘤 显微外科手术 颈静脉 颅底 

分 类 号：R739.91[医药卫生—肿瘤]