中颅窝底罕发肿瘤3例临床分析  

Clinical analysis of 3 cases of rare tumors in the base of middle cranial fossa

作　　者：陈绪清 廖华[1] 汪雷[1] 杨希林[1] CHEN Xuqing;LIAO Hua;WANG Lei;YANG Xilin(Dept.of Otolarynglogy,Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉-头颈外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第2期317-321,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨以耳科表现为首发症状的原发于中颅窝底肿瘤的诊疗方案,为临床诊治提供参考。方法:回顾并分析2016年1月—2019年12月武汉大学人民医院耳鼻咽喉头颈外科收治的3例中颅窝底肿瘤患者的临床资料,对其影像学表现、手术入路及随访结果进行分析。结果:3例患者的肿瘤侵犯范围主要包括颞骨鳞部及岩部、蝶骨大翼及蝶骨体、颞下窝及颞下颌关节等。2例采用耳前颞下-颞下窝入路,术中完全切除肿瘤,同时保留完整的中耳结构。1例患者由于中耳明显受侵采用Fisch颞下窝B型入路全切肿瘤,封闭外耳道。术后患者均无严重并发症发生。术后病理报告分别为骨巨细胞瘤、软骨肉瘤和软骨母细胞瘤,均属罕发肿瘤,随访12~34个月无复发。结论:高分辨率薄层CT和增强MRI扫描对中颅窝底肿瘤的病变范围和性质有良好的鉴别意义,仔细阅片可有效提高诊断准确率。应根据肿瘤侵犯范围个性化选择手术入路,相较于传统Fisch颞下窝B型入路,对于中耳结构未受侵犯的患者而言,其改良术式耳前颞下-颞下窝入路亦可提供较广泛清晰的视野,同时有助于保留患者的听力。Objective: To explore the diagnosis and treatment of primary tumors in the middle cranial fossa base with otologic manifestations as the first symptom, so as to provide reference for clinical diagnosis and treatment.Methods: We reviewed the clinical data of three patients with tumors of the middle cranial fossa in Department of Otorhinolaryngology Head and neck surgery, Renmin Hospital of Wuhan University from January 2016 to December 2019.Results: In all the three cases, the tumors mainly involved the scales and petrous parts of temporal bone, the greater wing and body of sphenoid bone, infratemporal fossa and temporomandibular joint. The tumors of two cases were completely removed through the anterior subtemporal infratemporal fossa approach, while the intact middle ear structure was preserved. One patient was treated with Fisch infratemporal fossa type B approach due to obvious middle ear invasion. No serious complications occurred. The postoperative pathological reports were giant cell tumor of bone, chondrosarcoma, and chondroblastoma, respectively, which were rare tumors. No recurrence was found during the follow-up of 12-34 months.Conclusion: High resolution thin-layer CT and enhanced MRI scanning have good differential diagnosis value in the range and nature of the lesions in the middle cranial fossa base tumors. Careful reading of the films can effectively improve the diagnostic accuracy. Compared with the traditional Fisch infratemporal fossa B approach,the modified infratemporal infratemporal fossa approach can provide a wide range of clear vision and help to retain the hearing of patients.

关 键 词：中颅窝 肿瘤 骨巨细胞瘤 软骨肉瘤 软骨母细胞 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]