枕下远外侧入路手术治疗枕骨大孔腹侧及颈静脉孔区肿瘤的临床分析  

Clinical analysis of suboccipital far lateral craniotomy for the treatment of tumors in the ventral foramen magnum and foramen jugular region

作　　者：钱升 张楠 李冬雪 夏成雨 Qian Sheng;Zhang Nan;Li Dongxue;Xia Chengyu(Department of Neurosurgery,Affiliated Provincial Hospital of Anhui Medical University,Hefei 230031,China)

机构地区：[1]安徽医科大学附属省立医院神经外科,合肥230031

出　　处：《中华神经外科杂志》2022年第5期476-481,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨枕下远外侧入路手术切除枕骨大孔腹侧及颈静脉孔区肿瘤的可行性和临床价值。方法回顾性分析2011年8月至2020年10月安徽医科大学附属省立医院神经外科收治的枕骨大孔腹侧及颈静脉孔区肿瘤患者的临床资料。其中枕骨大孔腹侧肿瘤14例,颈静脉孔区肿瘤21例。所有患者均应用枕下远外侧入路切除肿瘤。术后72 h内行MRI检查明确肿瘤的切除程度。采用Karnofsky功能状态评分(KPS)评估患者术后和随访期的神经功能状况。结果35例患者中,全切除32例(91.4%)、次全切除3例(8.6%)。无手术后死亡患者,无一例复发。术后发生中枢神经系统感染9例,脑脊液漏1例,经治疗后均痊愈。术后KPS为80~100分31例,<80分4例。31例获得随访,4例失随访,中位随访时间为19个月(1~110个月)。随访终点时,KPS为80~100分30例(96.8%),<80分1例(3.2%)。与术前KPS(80~100分23例,<80分12例)相比,术后KPS(P=0.008)和随访期KPS(P=0.002)均有改善。结论采用枕下远外侧入路手术切除枕骨大孔腹侧及颈静脉孔区肿瘤具有可行性,不良反应可控,可使患者获得较好的预后。Objective To investigate the feasibility and clinical value of microsurgical resection of tumors in the ventral foramen magnum and jugular foramen via a suboccipital far lateral approach.Methods The clinical data of patients with ventral foramen magnum tumors or jugular foramen tumors admitted to the Department of Neurosurgery of the Affiliated Provincial Hospital of Anhui Medical University from August 2011 to October 2020 were retrospectively analyzed.There were 14 cases of ventral foramen magnum tumors and 21 cases of jugular foramen tumors.All patients underwent tumor resection via suboccipital far lateral approach.MRI examination was performed within 72 h post operation to determine the degree of tumor resection.Karnofsky Performance Status Score(KPS)was used to evaluate the neurological status of the patients.Results Among the 35 patients,total resection was achieve in 32 patients(91.4%)and subtotal resection in 3(8.6%).No patient died after surgery,and no recurrence occurred.A total of 9 cases of central nervous system infection and 1 case of cerebrospinal fluid leakage occurred after operation,and all recovered after treatment.The postoperative KPS was 80-100 in 31 cases and<80 in 4 cases.Thirty-one cases were followed up,and 4 cases were lost to follow-up.The median follow-up time was 19 months(1-110 months).At the end of follow-up,KPS was 80-100 in 30 cases(96.8%)and<80 in 1 case(3.2%).Compared with preoperative KPS(80-100 in 23 cases and<80 in 12 cases),postoperative KPS(P=0.008)and KPS during follow-up(P=0.002)were improved.Conclusions Resection of tumors in the ventral foramen magnum and foramen jugular region by the far lateral suboccipital approach is feasible with controllable adverse reactions,and can lead to a good outcome.

关 键 词：中枢神经系统肿瘤 显微外科手术 治疗结果 枕骨大孔 颈静脉孔 

分 类 号：R739.4[医药卫生—肿瘤]