经扩大颅中窝硬膜外入路手术治疗颅内外沟通型三叉神经鞘瘤的临床疗效  

Clinical outcomes of microsurgery for trigeminal schwannomas with intra-extracranial extension via extended middle cranial fossa extradural approach

作　　者：牟磊[1] 秦军[1] 雷军荣[1] 陈志明[1] 冯驰[1] 杨青平 付锐[1] Mou Lei;Qin Jun;Lei Junrong;Chen Zhiming;Feng Chi;Yang Qingping;Fu Rui(Department of Neurosurgery,Shiyan Taihe Hospital,Shiyan 442000,China)

机构地区：[1]十堰市太和医院神经外科,湖北442000

出　　处：《中华神经外科杂志》2021年第3期265-269,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨经扩大颅中窝硬膜外入路手术治疗颅内外沟通型三叉神经鞘瘤的临床疗效。方法回顾性分析2013年1月至2019年12月十堰市太和医院神经外科收治的10例颅内外沟通型三叉神经鞘瘤患者的临床资料。10例患者的肿瘤最大直径为3.0~7.5 cm,7例肿瘤突破中颅底向颞下窝生长,3例肿瘤突入翼颚窝,2例肿瘤向颅后窝侵犯;10例患者的颅中窝、岩尖区骨质均有不同程度的破坏;2例肿瘤包裹颈内动脉岩骨段,3例肿瘤包裹颈内动脉海绵窦段。所有患者均采用经扩大颅中窝硬膜外入路手术治疗,术后1周内复查头颅CT和MRI。MRI显示肿瘤切除率100%为全切除,肿瘤切除率≥90%但<100%为次全切除,肿瘤切除率<90%为部分切除。定期门诊和电话随访患者,随访内容包括询问术后症状改善情况、复查头颅MRI评估肿瘤有无复发。结果10例患者中,肿瘤全切除8例,次全切除1例,部分切除1例。术后皮下积液2例,颅内感染1例,均在出院前治愈;术后新发手术同侧面部麻木感6例,动眼神经麻痹2例,不同程度的手术同侧咬合无力6例。无一例出现颅内出血或脑脊液漏。10例患者的随访时间为(24.7±4.3)个月(6~50个月);至末次随访,8例肿瘤全切除患者均未见肿瘤复发,另2例患者肿瘤复发;术后出现新发症状的患者,神经功能障碍均有不同程度好转。结论初步观察发现,经扩大颅中窝硬膜外入路手术切除颅内外沟通型三叉神经鞘瘤的肿瘤全切除比例较高,临床疗效较好。Objective To preliminarily explore the clinical efficacy of microsurgery for trigeminal schwannomas with intra-extracranial extension via extended middle cranial fossa extradural approach.Methods A retrospective analysis was conducted on the clinical data of 10 patients of trigeminal schwannomas with intra-extracranial extension via extended middle cranial fossa extradural approach admitted to Department of Neurosurgery,Shiyan Taihe Hospital from January 2013 to December 2019.The maximum diameter of tumors in 10 patients was 3.0-7.5 cm.The tumors broke through the middle skull base and grew into the infratemporal fossa in 7 cases,protruded into the pterygomaxillary fossa in 3 cases,and invaded into the posterior fossa in 2 cases.The middle cranial fossa and petrous apex in 10 patients were destroyed to varying degrees,the petrous segment of internal carotid artery was wrapped in 2 cases,and the cavernous segment of internal carotid artery was wrapped by tumor in 3 cases.All cases were treated by microsurgery via extended middle cranial fossa epidural approach,and the cranial CT and MRI were reexamined within 1 week after operation.The tumor resection rate of 100%showed on MRI was considered as total resection,≥90%and<100%as subtotal resection,and<90%as partial resection.Regular clinical visits and telephone follow-up were conducted.The follow-up included evaluation of the patients′functional status after surgery and reexamination of head MRI for detection of tumor recurrence.Results Of the 10 patients,total resection was achieved in 8 cases,subtotal resection in 1,and partial resection in 1 case.Subcutaneous effusion occurred in 2 cases,intracranial infection in 1,and all those complications were resolved before discharge.Postoperative newly-developed facial numbness on the operation side was reported in 6 cases,oculomotor nerve palsy in 2,ipsilateral masseter muscle weakness with varying degrees in 6.There was no case of intracranial hemorrhage or cerebrospinal fluid leakage.The 10 patients were followed up

关 键 词：神经鞘瘤 三叉神经 颅底 治疗结果 扩大颅中窝硬膜外入路 

分 类 号：R651.1[医药卫生—外科学]