颅中窝底内外沟通性三叉神经鞘瘤的外科治疗  

Surgical treatment strategies of middle skull base trigeminal schwannoma with extracranial extension

作　　者：白敬民 孟肖利[3] 万经海[3] 吴跃煌[4] Bai Jingmin Meng Xiaoli Wan Jinghai Wu Yuehuang(Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China Department of Neurosurgery Department of Head and Neck Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, National Cancer Center, Beijing 100021, China Department of Neurosurgery, Clinical College of Baodi, Tianjin Medical University, Tianjin 301800, China)

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院,100021 [2]天津医科大学宝坻临床学院神经外科,天津301800 [3]国家癌症中心北京协和医学院中国医学科学院肿瘤医院神经外科,100021 [4]国家癌症中心北京协和医学院中国医学科学院肿瘤医院头颈外科,100021

出　　处：《中国微侵袭神经外科杂志》2017年第5期193-196,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨颅中窝底内外沟通性三叉神经鞘瘤的临床特点和外科治疗策略。方法回顾性分析18例经手术及病理证实的颅中窝底内外沟通性三叉神经鞘瘤的临床表现、影像学特点、治疗及随访资料。结果肿瘤均一期全切。临床症状较前改善12例,无变化3例,加重3例。术后脑脊液漏1例,伤口渗血3例,硬膜外血肿1例,均治愈。病理结果示神经鞘瘤,其中良性14例,恶性4例。恶性病例术后均行放射治疗。术后平均随访31.4个月。恶性病例中,死亡1例,复发2例并再次行手术治疗,失访1例;良性病例无复发。结论颅中窝底内外沟通性三叉神经鞘瘤通常瘤体巨大,肿瘤主体位于颅内者选择颅中窝底硬膜外入路切除,主体位于颅外者选择上颌骨掀翻或颅底内镜手术切除。颅内外沟通性三叉神经鞘瘤恶变率较高,应尽量行根治性切除。恶性病例术后应放疗,以减少肿瘤复发。Objective To investigate the clinical features and surgical treatment strategies of middle skull base trigeminal schwannoma with extracranial extension. Methods The clinical and imaging features, surgical resection and follow-up data of 18 patients suffering middle skull base trigeminal schwannoma with extracranial extension were analyzed retrospectively. The middle skull base trigeminaf schwannoma with extracranial extension was diagnosed by surgery and pathology. Results All the tumors were totally resected by one-stage. Clinical symptoms were improved in 12 patients, no change was seen in 3 and worsened in 3. Cerebrospinal fluid leakage occurred in 1 patient, incision bleeding in 3 and epidural hematoma in 1. All of the complications were cured in the hospital. By postoperative pathology, benign tumor was revealed in 14 patients and malignant in 4. The 4 patients with malignant tumor received radiotherapy after surgery. All the patients were followed up for 31.4 months averagely. Among the 4 patients with malignant tumor, 1 patient was lost, 1 patient died, 2 patients underwent one more time surgery because of tumor recurrence. No recurrence was observed in the patients with benign tumor. Conclusions A middle skull base trigeminal schwannoma with extracranial extension usually has large tumor volume. A tumor which is mainly in the middle fossa can be resected via middle cranial fossa extradural approach. Otherwise, the tumor with larger extracranial extension can be resected via maxillary swing approach or endoscopic skull base surgery. Due to its high rate of malignancy, this kind of tumor should be totally resected. Radiotherapy is helpful to prevent its recurrence.

关 键 词：神经鞘瘤 三叉神经 颅底 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]