颞前经海绵窦入路个体化切除海绵窦区肿瘤31例回顾性分析  

Pretemporal transcavernous approach tailored surgery of cavernous sinus tumors： a consecutive series of 31 cases report

作　　者：苏君[1] 袁贤瑞[1] 赵子进[1] 王祥宇[1] 汪浚泉 肖凯[1] 李昊昱[1] 张弛[1] 袁健[1] 刘定阳[1] 刘庆[1] 

机构地区：[1]中南大学湘雅医院神经外科中南大学神经外科研究所湖南省颅底外科与神经肿瘤研究中心,长沙410008

出　　处：《中华外科杂志》2016年第5期367-371,共5页Chinese Journal of Surgery

基　　金：国家科技支撑计划资助项目（2014BAl04801）;湖南省科技厅科技计划重点项目（2013SK2022）

摘　　要：目的探讨颞前经海绵窦入路切除海绵窦区肿瘤的适应证及个体化手术策略。方法回顾性分析2012年5月至2015年9月中南大学湘雅医院神经外科采用颞前经海绵窦入路个体化手术连续治疗的31例海绵窦区肿瘤患者的临床资料、手术效果及术后并发症等。男性13例，女性18例，年龄17～67岁，平均年龄（41±14）岁。神经鞘瘤18例，脑膜瘤4例，海绵窦状血管瘤3例，侵袭性垂体腺瘤2例，脊索瘤、软骨瘤、转移性鼻咽癌、畸胎瘤各1例。术后3个月第一次随访并复查头部MRI平扫增强，若肿瘤进展或复发，建议行伽马刀治疗，每6个月复查一次，其他患者6个月后再次复查，之后每年复查一次。结果31例患者中肿瘤全切除22例（71．0％），次全切除6例（19．3％），大部分切除3例（9．7％），术后新增颅神经损伤7例（动眼神经4例，外展神经3例），原有颅神经症状加重5例（动眼、三叉神经各2例，外展神经1例），无围手术期死亡、颅内血肿、感染、脑脊液漏等病例。28例随访超过3个月，随访时间3-40个月，肿瘤进展1例，5例术后新增或颅神经麻痹加重患者的神经功能恢复。结论颞前经海绵窦入路适用于切除海绵窦内和同时累及海绵窦及其邻近区域的肿瘤，根据肿瘤生长范围及手术需要，个体化显露眶、颞下窝、后颅窝及鞍内鞍上等区域，创伤小、并发症少、肿瘤切除率高。Objective To investigate the indications of the pretemporal transcavernous approach for cavernous sinus tumors resection and design individually tailored surgery according to the extent of tumors and operation requirements. Methods A retrospective analysis of clinical data, surgical outcomes and complications in a series of 31 cases with cavernous sinus tumor operated via the individually tailored pretemporal transcavernous approach between May 2012 and September 2015 in Department of Neurosurgery, Xiangya Hospital, Central South University. There were 13 male and 18 female patients, aging from 17 to 67 years with a mean of （41 ± 14） years. The patients included 18 cases of shwannomas, 4 cases of meningiomas, 3 cases of cavernous hemangiomas, 2 cases of invasive pituitary adenomas, 1 case of chordoma, 1 case of chondroma, 1 case of recurrent teratoma, 1 case of metastatic nasopharyngeal carcinoma. The first followed-up visit was on the 3ra month after surgery, and if tumor progression or recurrence was observed on MRI, the Gamma knife treatment was recommended, the patient was followed up every 6 months, otherwise the patient was followed up again 6 months later, then, every 12 months. Results Gross total removal of tumors was achieved in 22 cases of 31 patients （71.0%）, containing 17 cases of shwannomas, 3 cases of hemangiomas, 1 case of chondroma, 1 case of teratoma; subtotal removal in 6 cases （ 19. 3% ） , including 3 cases of meningiomas, 1 case of pituitary adenoma, 1 case of chordoma, 1 case of metastatic carcinoma; partial removal in 3 cases （9.7%）, comprising 1 case of meningioma, 1 case of recurrent shwannoma, 1 case of recurrent pituitary adenoma. The symptoms of cranial never aggravated in 5 cases, the new postoperative cranial never palsy was observed in 7 cases. There was no surgical mortality, intracranial hematoma, intracranial infection and cerebrospinal fluid leakage cases, ect. Twenty-eight cases were followed up for more than 3 months （3 to 40 months）, 1 case of chordoma ha

关 键 词：脑肿瘤 海绵窦 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]