Dolenc入路手术治疗海绵窦肿瘤  

Microsurgery through Dolenc approach for patients with cavernous sinus tumor

作　　者：刘晗 连海伟[1] 简志宏[1] 邵灵敏[1] 余信远[1] 刘佳[1] 刘仁忠[1] LIU Han;LIAN Hai-wei;JIAN Zhi-hong;SHAO Ling-min;YU Xin-yuan;LIU Lia;LIU Ren-zhong(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2021年第4期225-228,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨经Dolenc入路手术治疗海绵窦肿瘤的疗效。方法回顾性分析2013年1月到2020年6月经Dolenc入路手术切除的60例海绵窦肿瘤的临床资料。结果肿瘤全切除36例,次全切除9例,大部分切除15例。术后病理显示55例(91.7%)为良性肿瘤,其中脑膜瘤27例,神经鞘瘤12例,垂体腺瘤12例。术后随访半年,颅神经损伤好转率为52.9%(27/51),术后头疼缓解率为85.7%(6/7),面部麻木好转率仅为33.3%(6/18)。术后新发神经受损症状40例,其中眼神经麻痹22例(56%,22/40),随访6个月好转16例(72.7%,16/22)。术后视力、视野好转率为50%(7/14);新发视力受损2例,随访6个月无明显改善。多因素logistic回归分析显示肿瘤包绕颈内动脉是肿瘤未全切除的独立危险因素(P<0.05)。结论海绵窦肿瘤多数为良性肿瘤,Dolenc入路手术切除肿瘤效果良好,但颈内动脉被肿瘤包绕不利于全切除肿瘤。Objective To explore the curative effectiveness of microsurgery through Dolenc approach for the patients with cavernous sinus tumor(CST).Methods The clinical data of 60 patients with CST who underwent microsurgery through Dolenc approach from January 2013 to June 2020 were retrospectively analyzed.Results Total tumor resection was achieved in 36 patients,subtotal in 9 and great partial in 15.Histopathological examination showed benign tumor in 55 patients(91.7%)of whom 27 were meningiomas,12 schwannogliomas and 12 pituitary adenomas.The 6-month follow-up results showed that the improvement rate of cranial nerve injury was 52.9%(27/51),the relief rate of headache was 85.7%(6/7),and the improvement rate of facial numbness was only 33.3%(6/18).New postopertive nerve damage symptoms occurred in 40 patients,of whom 22 patients(56%,22/40)were ophthalmic nerve palsy,and the improvement rate of ophthalmic nerve palsy was 72.7%(16/22).The improvement rate of visual acuity and visual field was 50%(7/14).Newly-onset visual acuity impairment occurred in 2 patients,and there was no significant improvement 6 months after the operation.Multivariate logistic regression analysis showed that the internal carotid artery surrounded by tumor was an independent risk factor for total tumor resection(P<0.05).Conclusion Most cavernous sinus tumors are benign.The microsurgery through Dolenc approach can obtain good outcome for the patients with CST,but the internal carotid artery surrounded by tumor is unfavorable to totally resect the tumors.

关 键 词：颅内肿瘤 海绵窦 Dolenc入路 显微手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]