经Dolenc入路显微手术切除海绵窦区肿瘤的疗效分析  

Analysis of clinical efficacy of microsurgical resection of cavernous sinus tumors via Dolenc approach

作　　者：秦军 雷军荣 牟磊 魏德胜 罗杰 Qin Jun;Lei Junrong;Mou Lei;Wei Desheng;Luo Jie(Department of Neurosurgery,Shiyan Taihe Hospital(Affiliated Hospital of Hubei University of Medicine),Shiyan 442000,China)

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)神经外科,十堰442000

出　　处：《中华神经外科杂志》2022年第3期267-271,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨经Dolenc入路切除海绵窦区肿瘤的手术技巧和疗效。方法回顾性分析十堰市太和医院(湖北医药学院附属医院)神经外科于2014年1月至2021年3月采用Dolenc入路切除的36例海绵窦区肿瘤患者的临床资料,其中神经鞘瘤13例、海绵状血管畸形5例、脑膜瘤8例,侵袭性垂体腺瘤4例、脊索瘤和软骨肉瘤各2例、表皮样囊肿和皮样囊肿各1例。评估肿瘤的切除程度和手术并发症,随访肿瘤的复发和进展程度。结果36例患者,肿瘤全切除29例(80.6%),次全切除4例(11.1%),大部分切除3例(8.3%)。术后新增(8例)或原有神经功能缺损症状加重(5例)者共13例;无一例患者发生颅内出血、脑脊液漏等并发症。36例患者的中位随访时间为13个月(3~73个月)。次全切除者中,3例脑膜瘤患者术后行伽玛刀治疗;1例神经鞘瘤患者术后50个月复发,再次手术全切除;4例患者肿瘤均无进展或复发。3例大部分切除者中,2例侵袭性垂体腺瘤患者术后行伽玛刀治疗,其中1例于术后26个月肿瘤复发死亡,1例肿瘤无进展;1例复发性脊索瘤患者,术后11个月再次复发,放弃治疗。全切除中的2例软骨肉瘤患者,1例脊索瘤患者术后行放射治疗,随访无复发。13例有神经功能缺损症状者,随访期8例恢复。结论经Dolenc入路切除海绵窦区肿瘤可以充分显露病变及重要的神经、血管,减少脑组织牵拉,提高手术的安全性和肿瘤的全切除程度。Objective To explore the surgical skills and therapeutic effect of resection of cavernous sinus tumors via Dolenc approach.Methods A retrospective analysis was conducted on the clinical data of 36 patients with cavernous sinus tumors resected via the Dolenc approach at the Department of Neurosurgery,Shiyan Taihe Hospital(Affiliated Hospital of Hubei University of Medicine)from January 2014 to March 2021,including 13 cases of schwannoma,5 cases of cavernous hemangioma,8 cases of meningioma,4 cases of invasive pituitary adenoma,2 cases of chordoma,2 cases of chondrosarcoma,1 case of cholesteatoma and 1 case of dermoid cyst.The degree of tumor resection and surgical complications were evaluated,and the degree of tumor recurrence and progression was followed up.Results Of the 36 patients,29(80.6%)had total tumor resection,4(11.1%)had subtotal tumor resection,and 3(8.3%)had major tumor resection.There were 13 cases of new-onset(8 cases)or aggravated symptoms of neurological deficit(5 cases)post operation;none of the patients had complications such as intracranial hemorrhage and cerebrospinal fluid leakage.The median follow-up time of the 36 patients was 13 months(range:3-73 months).Among the patients with subtotal resection,3 patients with meningioma underwent Gamma Knife treatment after operation;1 patient with schwannoma recurred 50 months after operation and underwent total resection again;those 4 patients had no tumor progression or recurrence.Among the 3 patients undergoing major resection,2 patients with invasive pituitary adenoma underwent Gamma Knife treatment after surgery,of which 1 patient died of tumor recurrence 26 months after surgery,and 1 patient had no tumor progression;1 patient of chordoma had recurrence at 11 months after surgery and did not undergo further treatment.In total resection group,2 cases of chondrosarcoma and 1 case of chordoma underwent postoperative radiotherapy,and no recurrence was found during follow-up.Among 13 patients with symptoms of neurological deficit,8 recovered during the

关 键 词：海绵窦 脑肿瘤 显微外科手术 治疗结果 Dolenc入路 

分 类 号：R739.41[医药卫生—肿瘤]