枕骨大孔区肿瘤的显微外科治疗探讨  

Microsurgical treatment of tumors in the foramen magnum region

作　　者：梅鹏金 苗发安 张慧 陈晨 张磊 纪培志 范月超 MEI Pengjin;MIAO Fa'an;ZHANG Hui;CHEN Chen;ZHANG Lei;JI Peizhi;FAN Yuechao(Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院神经外科

出　　处：《徐州医科大学学报》2019年第10期718-720,共3页Journal of Xuzhou Medical University

基　　金：国家自然科学基金青年科学基金(81502160);江苏省“科教强卫工程”青苗人才项目(QNRC2016785)

摘　　要：目的探讨枕骨大孔区肿瘤的临床特点、手术方式及手术技巧。方法总结徐州医科大学附属医院神经外科自2011年6月-2018年10月采用显微外科治疗的20例枕骨大孔区肿瘤患者的临床资料,其中脑膜瘤11例,神经鞘瘤4例,血管母细胞瘤2例,血管外皮瘤1例,神经纤维肉瘤1例,骨软骨瘤1例。根据肿瘤起源、主体部分及结合MRI特点将肿瘤分为3型:Ⅰ型,肿瘤主要位于枕骨大孔后方,包括基底起源于枕骨大孔后方,总共10例;Ⅱ型,肿瘤主要位于枕骨大孔侧方,总共6例;Ⅲ型,肿瘤主要位于枕骨大孔前方,总共4例。采用3种手术入路切除肿瘤:枕下后正中入路13例,改良枕下乙状窦后入路4例,枕下远外侧入路3例。结果肿瘤全切19例,大部分切除1例。无术中死亡病例,其中1例术后呼吸麻痹,行气管切开,1个月后死于肺部感染;临床症状改善14例;保持术前症状3例;术后症状加重4例,包括新的神经症状、肢体运动障碍和呼吸麻痹。结论采用显微外科手段治疗枕骨大孔区肿瘤效果满意;根据术前位置分型选择合理手术入路是安全有效切除肿瘤的关键。Objective To investigate the clinical features,surgical methods and techniques of tumors in the foramen magnum region.Methods Clinical data were analyzed using information from 20 patients who were admitted in Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University from June 2011 to October 2018 and treated with microsurgery due to tumors in the foramen magnum region.It included 11 cases of meningioma,4 cases of schwannoma,2 cases of hemangioblastoma,1 case of angiothelioma,1 case of neurofibrosarcoma and 1 case of osteochondroma.According to the origin,main body and MRI results,the tumors were divided into three types:type Ⅰ tumor which was mainly located behind the foramen magnum,including the basilar origin of the foramen magnum,a total of 10 cases;type Ⅱ tumor which was mainly located in the side of the foramen magnum,a total of 6 cases;type Ⅲ tumor which was mainly located in front of the foramen magnum,a total of 4 cases.Three surgical approaches were used for tumor removal:the suboccipital posterior median approach in 13 patients,the suboccipital retrosigmoid sinus approach in 4 patients,and the suboccipital far lateral approach in 3 patients.Results Total tumor resection was performed in 19 cases and major resec?tion in 1 case.There were no reports of death during surgery.One patient underwent tracheotomy due to postoperative respiratory paralysis and died of pulmonary infection 1 month later.Clinical symptoms were improved in 14 cases.Preoperative symptoms were maintained in 3 cases.Postoperative symptoms were aggravated in 4 patients,including new neurological symptoms,limb movement disorder and respiratory paralysis.Conclusions The effect of microsurgical treatment of tumor in the foramen magnum region is satisfactory.It is essential to choose proper surgical approach according to preoperative position classification for safe and effective tumor resection.

关 键 词：枕骨大孔 颅内肿瘤 显微手术 手术入路 

分 类 号：R739.41[医药卫生—肿瘤]