内镜经口入路切除颅内外沟通型舌下神经鞘瘤  

Endoscopic transoral approach for the intra- and extracranial growth hypoglossal schwannoma

作　　者：张秋航[1] 郭宏川[1] 孔锋[1] 陈革[1] 李銘初 梁建涛[1] 鲍遇海[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院颅底外科中心,北京100053

出　　处：《中国微侵袭神经外科杂志》2014年第1期5-9,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨内镜经口入路切除颅内外沟通型舌下神经鞘瘤的新方法。方法回顾性分析12例颅内外沟通型舌下神经鞘瘤病人的临床资料，其中舌下神经麻痹12例，迷走神经麻痹8例。舌咽神经麻痹4例。本组均采用单纯内镜经口入路切除肿瘤。结果12例舌下神经鞘瘤均获得全切除，且保留了该区域的脑神经。术后出现暂时性吞咽困难及病侧迷走神经麻痹1例，于术后3个月恢复；脑脊液漏并发脑膜炎1例，经抗炎治疗，并于术后16d行经口入路2次修补治愈。未发生其他并发症。随访6-37个月，病人手术前后迷走神经和舌咽神经麻痹均改善和恢复，舌肌运动改善，半舌萎缩无明显变化；无复发病例。结论内镜经口入路使用囊内切除肿瘤方法可安全、彻底、微创切除颅内外沟通型舌下神经鞘瘤，并能保留和改善后组脑神经功能。Objective To discuss a new method for resecting intra- and extracranial growth hypoglossal schwannoma via endoscopic transoral approach. Methods Clinical data of 12 patients with intra- and extracranial growth hypoglossal schwannoma were analyzed retrospectively, including hypoglossal palsy in 12 patients, vagus nerve palsy in 8 and glossopharyngeal nerve palsy in 4. The tumors were resected via a endoscopic transoral approach alone. Results Total tumor removal was achieved in 12 patients, and cranial nerves kept in the region. One patient suffered from temporary swallowing difficulties and right vagus palsy, and recovered 3 months after the surgery. One patient with cerebrospinal fluid leak complicated by meningitis was cured via antibiotic therapy and secondary repair by endoscopic transoral approach 16 days after the surgery. There were no other complications. During a follow-up period of 6 to 37 months, the motor and glossopharyngeal and vagus palsies improved, but semi-tongue muscle atrophy had no obvious change, and no patient recurred. Conclusion The endoscopic transoral approach and intracapsular removal of the tumor is a safe and minimally invasive surgical method for intra- and extracranial growth hypoglossal schwannoma, and can keep and improve the function of posterior cranial nerves.

关 键 词：神经鞘瘤 舌下神经 颅底 手术入路 经口 神经内镜 

分 类 号：R739.4[医药卫生—肿瘤]