经岩骨入路切除颈静脉孔区肿瘤的临床分析  

Clinical analysis of resection of jugular foramen tumors through transpetrosal approach

作　　者：张明山[1] 张宏伟[1] 谷春雨[1] 王浩然[1] 曲彦明[1] 宁威海 孙鹏 曹建平 闫长祥[1] 于春江[1] Zhang Mingshan;Zhang Hongwei;Gu Chunyu;Wang Haoran;Qu Yanming;Ning Weihai;Sun Peng;Cao Jianping;Yan Changxiang;Yu Chunjiang(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 200093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《中华神经外科杂志》2021年第11期1097-1101,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨采用经岩骨入路切除颈静脉孔区肿瘤的临床疗效。方法回顾性分析2015年10月至2020年5月首都医科大学三博脑科医院神经外科采用经岩骨入路手术治疗36例颈静脉孔区颅内外沟通性肿瘤患者的临床资料。包括神经鞘瘤12例、颈静脉球瘤7例、脑膜瘤6例、软骨肉瘤4例、血管周细胞瘤2例、转移癌2例、透明细胞癌1例、海绵状血管畸形1例、鳞癌1例。颈静脉球瘤主要为Fisch分级C级和D级,神经鞘瘤主要为Kaye-Pellet分型B型或D型。肿瘤的生长方式:局限于颅内-岩骨2例,岩骨内8例,岩骨-颈部12例,颅内-岩骨-颈部14例。手术入路包括Fisch颞下窝A型入路(12例)、经岩枕入路(8例)和迷路下经乳突入路(16例)。患者术后定期行临床及影像学随访。结果36例患者中,肿瘤全切除14例,近全切除18例,大部切除4例。术后出现脑脊液鼻漏2例,经手术修补后均好转;出现脑脊液耳漏1例,经保守治疗后好转;出现脑梗死1例,出院前症状好转;出现切口皮下积液1例,切口感染1例,经对症治疗后均缓解。36例患者的中位随访时间为24个月(8〜62个月),共29例(80.6%)患者术后脑神经功能改善(9例)或无变化(20例);症状加重7例,其中面瘫加重3例,后组脑神经麻痹加重4例;术后新发面瘫1例,颈静脉球瘤复发1例。结论经岩骨入路手术对侵犯岩骨及颈部的颈静脉孔区肿瘤显露充分,其肿瘤全切除及近全切除率相对较高,而且术后并发症较少。Objective To explore the clinical efficacy of surgical resection of jugular foramen tumors through transpetrosal approach.Methods A retrospective analysis was conducted on the clinical data of 36 patients with intracranial and extracranial communicating tumors in the jugular foramen region resected through transpetrosal approach at the Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University from October 2015 to May 2020.Those tumors included 12 cases of schwannoma,7 cases of glomus jugular tumor,6 cases of meningioma,4 cases of chondrosarcoma,2 cases of perivascular cell tumor,2 cases of metastatic cancer,1 case of clear cell carcinoma,1 case of cavernous vascular malformation and 1 case of squamous cell carcinoma.Glomus jugular tumors were mainly classified as Fisch grades C and D,and schwannomas were mainly classified as Kaye-Pellet type B or D.According to the growth pattern,those tumors were confined to the intracranial-petrous region in 2 cases,petrous bone in 8 cases,petrous bone-neck region in 12 cases,or intracranial-petrous bone-neck region in 14 cases.Surgical approaches included Fisch type A infratemporal fossa approach was used in 12 cases,petrosal occipital approach in 8 cases,and sublabyrinthine transmastoid approach in 16 cases.Patients underwent regular clinical and imaging follow-up after surgery.Results Among the 36 patients,total resection was achieved in 14 cases,subtotal resection in 18 cases,and major resection in 4 cases.Two cases of cerebrospinal fluid rhinorrhea occurred after operation,and all improved after surgical repair.One case of cerebrospinal fluid otorrhea occurred,which improved after conservative treatment.One case of cerebral infarction occurred after operation and recovered before discharge.Postoperative subcutaneous fluid around incision was reported in 1 case,infection of incision developed in 1 case,and both resolved after symptomatic treatment.The median follow-up time of 36 patients was 24 months(8-62 months).A total of 29(80.6%)patients had improved p

关 键 词：脑肿瘤 神经外科手术 颈静脉孔 经岩骨入路 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]