枕骨大孔区肿瘤的临床分型及显微外科治疗  

Clinical classification and microsurgical treatment of foramen magnum tumors

作　　者：陈海锋[1] 李丹[2] 吴虹刚[1] 刘家刚[1] 黄思庆 

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]成都中医药大学基础医学院生理教研室

出　　处：《中华神经外科杂志》2014年第7期703-706,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：四川省科技支撑计划项目（2011SZ0222）

摘　　要：目的 探讨枕骨大孔区肿瘤的临床分型及显微外科手术方式和技巧.方法 回顾性分析显微外科手术切除的102例枕骨大孔区肿瘤的临床资料,根据影像学资料对肿瘤进行临床分型：（1）腹侧型：肿瘤位于延颈髓腹侧（3例,2.9％）;（2）外侧型：肿瘤位于延颈髓侧方（85例,83.3％）;（3）髓内型：肿瘤位于延颈髓髓内（14例,13.7％）.根据分型采用不同的手术方式一期切除肿瘤,其中腹侧型和髓内型采用枕颈后正中双侧入路;而外侧型则采用枕颈后正中单侧入路.结果 肿瘤全切除96例（94.1％）,次全切除4例,部分切除2例.术后随访3个月～8年（平均3.6年）,临床症状改善97例（95.1％）,加重5例;复发4例,无发生脊柱畸形的病例.结论 根据枕骨大孔区肿瘤分型来选择手术方式,不仅能提高肿瘤全切率,而且有利于减少手术创伤,从而最大限度地维持枕颈交界区的稳定性.Objective To explore the clinical classification,microsurgical operation methods and techniques of the tumors located at foramen magnum region.Methods 102 cases of foramen magnum tumors were resected by microsurgical operations in neurosurgery department of West China Hospital of Sichuan University from September 2005 to September 2013,and the clinical data of all cases were retrospectively analyzed.According to the results of clinical imaging,these cases with foramen magnum tumors were classified into 3 clinical types as follows：（1） Ventral type：tumor was located at ventral of medulla oblongata-cervical spinal cord,and there were 3 cases （2.9%） of meningioma belonging to such type; （2） Lateral type：tumor was located at lateral,ventrolateral or dorsolateral of medulla oblongata-cervical spinal cord,and there were 85 cases （83.3%） belonging to such type,including 35 cases of meningioma,48 cases of schwannoma and 2 cases of epidermoid cyst; （3）Intramedullary type：tumor was located in medulla of medulla oblongata-cervical spinal cord,and there were 14 cases （13.7%） belonging to such type,including 5 cases of ependymoma,7 cases of hemangioblastom a,and 2 cases of cavernous hemangioma.All cases of these foramen magnum tumors were resected in one-stage,and these tumors were resected by different microsurgical operation methods according to clinical classification.The tumors of ventral and intramedullary types were reseeted by posterior occipitocervical bilateral approach,while the lateral type by posterior occipitocervical unilateral approach.Results 96（94.1%） cases of foramen magnum tumors were totally resected,4 subtotally resected,and 2 partially resected.The follow-up period ranged from 3 months to 8 years （mean duration：3.6 years）.The clinical manifestation was improved in 97（95.1%）cases,aggravated in 5,4 recurred and there was no spinal deformity.Conclusions Using the clinical classification of foramen magnum tumors to guide the choice of surgical approach not only im

关 键 词：枕骨大孔 肿瘤 临床分型 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]