基于改良Samii分型治疗颈静脉孔区神经鞘瘤的临床疗效  

Clinical efficacy of treatment of jugular foramen schwannoma based on the modified Samii classification

作　　者：陶晓刚 魏新亭[1] 薛亚轲[1] 杨凤东[1] 王晓涛[1] Tao Xiaogang;Wei Xinting;Xue Yahe;Yang Fengdong;Wang Xiaotao(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第一附属医院神经外科,450003

出　　处：《中华神经外科杂志》2021年第9期923-927,共5页Chinese Journal of Neurosurgery

基　　金：河南省高等学校重点科研项目(19A320075)。

摘　　要：目的探讨基于改良Samii分型个体化选择手术入路、显微外科手术治疗颈静脉孔区神经鞘瘤(JFS)的临床疗效及术中神经保护策略。方法回顾性分析2015年1月至2019年12月郑州大学第一附属医院神经外科收治的28例JFS患者的临床和影像学资料。术前根据改良Sami分型将肿瘤分为A~D型,个体化选择手术入路;6例A型肿瘤采用枕下经乙状窦后入路,2例B1型采用枕下经颈静脉突人路,5例B2型采用枕下经乙状窦后联合经颈静脉突入路,3例B3型采用经颈静脉突-颈外侧入路,4例C型采用颈外侧入路,8例D型采用枕下经乙状窦后入路联合经颈静脉突-颈外侧入路。所有患者于术后3、6、12个月采用门诊复查等方式进行随访。复查头颅MRI评估肿瘤切除程度,采用House-Brackmann(H-B)分级评估面神经麻痹的严重程度,术后12个月评估患者的改良Rankin量表评分(mRS)。结果28例患者均顺利完成手术,肿瘤全切除25例,次全切除3例。围手术期脑神经并发症主要包括后组脑神经麻痹加重8例,面神经麻痹加重2例,无颅内血肿、二次手术及死亡病例。28例患者的随访时间为(35±9)个月(12~70个月)。术后12个月,mRS为0~1分者16例,2分9例,3分3例。至末次随访,3例肿瘤次全切除的患者肿瘤均无进展;25例肿瘤全切除的患者均未见肿瘤复发;遗留部分后组脑神经麻痹患者5例,H-B分级大于Ⅲ级的面神经麻痹患者3例。结论基于改良Samii分型个体化选择手术入路,遵循颅底手术微创化的理念,采用显微外科手术治疗JFS可获得满意的临床疗效。Objective To explore the clinical efficacy and intraoperative neuroprotection strategies of individualized selection of surgical approach and microsurgery for jugular foramen schwannoma(JFS)based on the modified Samii classification.Methods The clinical and imaging data of 28 patients with JFS admitted to the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2019 were retrospectively analyzed.Before surgery,the tumors were classified into types A to D according to the modified Samii classification,and the surgical approach was individualized;6 cases of type A tumors were treated with the suboccipital retrosigmoid approach,2 cases of type B1 with the suboccipital transjugular process approach,5 cases of type B2 with suboccipital retrosigmoid combined with transjugular process approach,3 cases of type B3 with transjugular process and lateral cervical approach,4 cases of type C with lateral cervical approach,and 8 cases of type D with suboccipital retrosigmoid approach combined with transjugular process and lateral cervical approach.All patients were followed up at 3,6,and 12 months after the operation.Head MRI was performed to assess the degree of tumor resection,the House-Braekmann(H-B)grade was used to assess the severity of facial nerve palsy,and the patient's modified Rankin Scale score(mRS)was assessed 12 months after surgery.Results All 28 patients successfully underwent the operation.Total tumor resection was performed in 25 cases and subtotal resection in 3 cases.The perioperative cranial nerve complications mainly included 8 cases of aggravated palsy of the posterior cranial nerve and 2 cases of aggravated facial nerve palsy.There was no intracranial hematoma,second operation or death cases.The follow-up time of 28 patients was 35±9 months(12-70)months.At 12 months post operation,16 cases had a score of 0 to 1,9 cases were scored 2 and 3 cases were scored 3.At the last follow-up,3 patients with subtotal tumor resection showed no tumor progressio

关 键 词：神经鞘瘤 显微外科手术 治疗结果 颈静脉孔 个体化 

分 类 号：R739.4[医药卫生—肿瘤]