血流重建在累及颈内动脉的颅底肿瘤治疗中的应用分析  

Application analysis of cerebral revascularization in the treatment of skull base tumors involving internal carotid artery

作　　者：孙增峰[1,3] 施铭岗 尚彦国[2] 佟小光[2] Sun Zengfeng;Shi Minggang;Shang Yanguo;Tong Xiaoguang(Clinical College of Neurology,Neurosurgery and Neurorehabilitationf Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery and Neuro-oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,300070 [2]天津市环湖医院神经外科,300350 [3]天津医科大学肿瘤医院脑系肿瘤科,300060

出　　处：《中华神经外科杂志》2021年第11期1108-1113,共6页Chinese Journal of Neurosurgery

基　　金：天津市科委重大专项(18ZXDBSY00180)。

摘　　要：目的探讨累及颈内动脉(ICA)的颅底肿瘤血流重建术式的选择及临床疗效。方法回顾性分析2016年4月至2020年9月天津市环湖医院神经外科收治的10例累及ICA的颅底肿瘤患者的临床资料。其中脑膜瘤6例, 垂体腺瘤2例, 恶性软骨肉瘤1例, 鼻咽癌1例。根据肿瘤的起源部位、侵犯部位及侧支循环的代偿情况, 分别采用经Dolenc入路切除肿瘤联合颞浅动脉-大脑中动脉搭桥术(3例)、扩大中颅底入路切除肿瘤并联合FukushimaⅠ型搭桥术(3例)、扩大中颅底入路切除肿瘤并联合Fukushima Ⅲ型搭桥术(2例)、Dolenc入路或扩大中颅底入路肿瘤切除并联合原位血管直接吻合术(2例)。术后行影像学检查评估吻合血管的通畅情况、肿瘤切除程度、有无脑缺血及肿瘤有无复发等。结果 10例患者术中荧光造影均显示吻合血管通畅, 术后8例行数字减影血管造影(DSA)或CT血管成像(CTA)复查证实吻合血管通畅, 2例因术后昏迷未行DSA或CTA检查。肿瘤全切除7例, 近全切除1例, 部分切除1例, 1例ICA破裂出血的鼻咽癌患者仅行血管搭桥术, 未行肿瘤切除术。术后1例发生脑缺血患者经药物治疗后好转;2例术后出现面部麻木及面瘫, 于3个月后恢复;1例累及两侧海绵窦斜坡的脑膜瘤患者一期行血管重建联合肿瘤切除术后恢复顺利, 但因二期对侧肿瘤切除术后昏迷, 自动出院;1例术后15 d因呼吸衰竭死亡。9例患者的随访时间为4~26个月, 末次随访显示, 患者均未出现新发脑缺血, 其中6例行DSA或CTA复查, 显示5例吻合血管通畅, 1例吻合血管部分狭窄。1例恶性软骨肉瘤术后5个月复发, 1例脊索型脑膜瘤术后1年复发, 其余患者未见肿瘤复发。结论对于累及ICA的颅底肿瘤, 根据脑血流代偿情况、肿瘤位置及ICA受累程度选择不同的血流重建术, 可以降低术中出血及术后脑缺血的发生率, 同时提高肿瘤的切除程度。Objective To discuss the selection,technical points and therapeutic effect of cerebral revascularization for skull base tumors involving internal carotid artery(ICA).Methods A retrospective analysis was conducted on the clinical data of 10 patients with skull base tumors involving ICA admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from April 2016 to September 2020.There were 6 cases of meningiomas,2 cases of pituitary adenoma,1 case of chondrosarcoma,and 1 case of nasopharyngeal carcinoma.According to the tumor s origin,invasion site,and compensation of collateral circulation,the tumors were removed through Dolenc approach combined with STA-MCA bypass in 3 cases,through extended middle fossa approach combined with Fukushima bypass Ⅰ in 3 cases,through extended middle fossa approach combined with Fukushima bypass Ⅲ in 2 cases,and through Dolenc approach or extended middle fossa approach combined with direct reconstruction in 2 cases.Postoperative imaging examination was perfonned to assess the patency of the anastomosed blood vessel,the degree of tumor resection,the presence or absence of cerebral ischemia,and the presence or absence of tumor recurrence.Results Intraoperative fluoroscopy in 10 patients showed patency of the anastomotic vessels,8 patients underwent digital subtraction angiography(DSA)or GT angiography(CTA)after the operation to confirm that the anastomoses were patent,and 2 patients did not receive DSA or CTA due to postoperative coma.Total resection was achieved in 7 cases,subtotal resection in 1 case,partial resection in 1 case,and 1 case of nasopharyngeal carcinoma wth ICA rupture and bleeding only underwent vascular bypass surgery-without tumor resection.One case of cerebral ischemia improved after medical treatment;2 cases developed facial numbness and facial paralysis,and recovered after 3 months;1 case of meningioma involving bilateral slopes of cavernous sinuses underwent cerebral revascularization combined with tumor resection.The recovery went smoothly,but the p

关 键 词：颅底肿瘤 颈内动脉 脑血管重建术 治疗结果 

分 类 号：R739.4[医药卫生—肿瘤]