源于颈静脉孔区的神经鞘膜瘤的处理  

Management of jugular foramen Schwannomas

作　　者：孙艳[1] 黄琦[1] 杨军[1] 汪照炎[1] 吴皓[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科上海交通大学医学院耳科学研究所,200092

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第7期546-550,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（81371086）

摘　　要：目的 探讨源于颈静脉孔区的神经鞘膜瘤手术方式的选择以及术中面神经、后组颅神经功能的保护方法.方法 回顾性分析2002年12月-2012年5月在上海交通大学医学院附属新华医院耳鼻咽喉头颈外科接受手术治疗的38例源于颈静脉孔区的神经鞘膜瘤患者的临床资料,包括临床表现、手术方式的选择、肿瘤切除情况以及术后面神经、后组颅神经功能的随访结果.结果 38例患者中男18例,女20例;年龄21～70岁（平均45.3岁）.术前主要临床表现：27例患者（71.1％）表现为头痛及颈部疼痛,9例患者（23.7％）表现为颈部肿块;颅神经损伤主要表现为迷走神经损伤,21例患者（55.3％）术前出现迷走神经受损表现.MRI检查,跨颅内-外型19例,颅内型10例,颅外型9例.根据肿瘤的生长部位和范围选择手术切除的径路,25例采用颞下窝A型径路,5例采用岩枕跨乙状窦径路,8例颅外型神经鞘膜瘤患者采用颈侧径路切除肿瘤.肿瘤全切率为92.1％（35/38）;2例患者针对残余肿瘤进行了辅助放射治疗.所有患者的肿瘤最终都得到控制,出院后6个月至1年复查MRI,之后每隔1～2年进行一次影像学随访并对颅神经功能进行分析评估.随访26 ～ 124个月（中位随访时间为62.3个月）,36例患者（94.7％）保留了良好的面神经功能,所有患者均无吞咽障碍,后组颅神经功能均得到完全代偿.结论 术前评估肿瘤性质和位置对源于颈静脉孔区的神经鞘膜瘤手术方法的制定至关重要,正确的手术方法和术中仔细操作能使面神经及后组颅神经的功能得到最大程度的保护.对一些特殊病例,手术切除肿瘤后再行放射治疗是一种有效的肿瘤控制方法.Objective To discuss surgical approach selection and treatment strategy for preservation of the facial and lower cranial nerves＇ function in jugular foramen schwannomas surgery.Methods Retrospectively analyzed the clinical presentation,surgical approaches selection,facial and lower cranial nerves follow-up outcomes of 38 jugular foramen Schwannomas,who received operations in the Department of Otolaryngology Head and Neck Surgery,Xinhua Hospital affiliated to Shanghai Jiaotong University,School of Medicine during 2002 and 2012.Results A total of 38 patients,including 18 men and 20 women,with ages ranged from 21 to 70 years（mean 45.3）.Headache or neck pain in preoperative clinical presentation was present in 27 patients （71.1%） and cervical mass in 9 patients （23.7%）.Cranial nerve impairments,mainly the vagus nerve,were present in 21 patients（55.3%）.MRI finding：19 tumors were intra-and extracranial,10 were intracranial and 9 were extracranial.According to the tumor location and region,select the surgical approaches.25 patients used infratemporal fossa type A approach,5 patients used petrous occipital transsigmoid approach and 8 patients used transcervial approach to remove tumors.The percentage of total resection was 92.1% （35/38）.Adjunctive radiosurgery was used in the management of residual tumor in two patients.All cases obtained ultimately tumor control.Patients were followed by MRI every 6 months for 1 year.Thereafter,they performed follow-up imaging every 1-2 years,and the cranial nerve function was analyzed and evaluated.They were followed up from 26-124 months（median follow-up was 62.3 months）.During follow-up period,good facial function was obtained in 36 patients （94.7%）.All patients had no swallowing disorder.Complete comnpensation of lower cranial nerve function was achieved in all patients.Conclusions The preoperative estimation and location of tumor in nature is of great importance in the determination of proper surgical planning of jugular foramen Schwannomas.Facial ne

关 键 词：头颈部肿瘤 神经鞘瘤 面神经 颅神经 外科手术 

分 类 号：R739.91[医药卫生—肿瘤]