高流量颈外动脉-大脑中动脉搭桥术在中颅窝肿瘤手术中的应用  

Application of high-flow external carotid artery-middle cerebral artery bypass in the middle cranial fossa tumor surgery

作　　者：白斌 王东[1] 张川[1] 苏少波[1] 雪亮[1] 岳树源[1] Bai Bin;Wang Dong;Zhang Chuan;Su Shaobo;Xue Liang;Yue Shuyuan(Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Neurosurgery,Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津医科大学总医院神经外科,天津300052 [2]天津市第五中心医院神经外科,天津300450

出　　处：《中华神经外科杂志》2022年第6期597-601,共5页Chinese Journal of Neurosurgery

基　　金：京津冀专项(19JCZDJC64600Z);天津市科技计划(15ZXLCSY00060)。

摘　　要：目的初步探讨高流量颈外动脉-大脑中动脉搭桥在中颅窝肿瘤手术中的应用效果。方法回顾性分析天津医科大学总医院神经外科2014年1月至2020年1月采用肿瘤切除术联合高流量颈外动脉-大脑中动脉搭桥术治疗的5例中颅窝肿瘤患者的临床资料。其中,原发肿瘤2例,复发肿瘤3例。桥血管为大隐静脉者2例,为桡动脉者3例。术后根据头颅MRI增强扫描评估肿瘤切除程度,以手术区域内无肿瘤强化为肿瘤全切除。术后3个月及以后每年进行影像学及电话随访。影像学随访包括头颅MRI、数字减影血管造影(DSA)或CT血管成像(CTA)。电话随访评估Karnofsky功能状态评分(KPS)及相关神经功能。结果5例患者均成功行前循环的颅内外血运重建。5例均达到影像学上的肿瘤全切除。病理学结果显示,脑膜瘤4例,孤立性纤维性肿瘤1例。术后5例患者的复查头颅CTA结果均提示桥血管通畅。2例原发肿瘤患者术后出现患侧第Ⅱ、Ⅲ、Ⅳ、Ⅵ脑神经损伤,其中1例出现第Ⅴ脑神经功能障碍;3例复发肿瘤患者中,患侧眼失明1例。5例患者围手术期均未出现严重的脑缺血或出血事件。5例患者的术后中位随访时间为3年(1~5年)。随访期间,海绵窦内神经功能障碍改善4例。5例患者术后1个月的KPS为60~70分,术后12个月为80~90分。至末次随访,5例患者的肿瘤均无进展或复发表现;复查头颅CTA或DSA结果均提示桥血管通畅,无明显血管狭窄。结论初步观察发现,采用高流量颈外动脉-大脑中动脉搭桥后再行肿瘤切除手术治疗复杂中颅窝肿瘤,肿瘤全切除率和桥血管通畅率高,严重缺血性卒中事件发生率低,总体临床疗效好。Objective To investigate the effectiveness of high-flow intracranial and extracranial vascular bypass in the surgery for middle cranial fossa tumors.Methods A retrospective analysis was conducted on the clinical data of 5 patients with middle cranial fossa tumors treated by tumor resection combined with high-flow external carotid artery-middle cerebral artery bypass from January 2014 to January 2020 in the Department of Neurosurgery of Tianjin Medical University General Hospital.Among them,2 cases were primary tumors and 3 cases were recurrent tumors.The bridging vessel was the great saphenous vein in 2 cases and the radial artery in 3 cases.Postoperatively,the degree of tumor resection was evaluated according to the enhanced brain MRI scan,and no tumor enhancement in the surgical area was considered as total tumor resection.Imaging and telephone follow-up was performed 3 months after surgery and annually thereafter.Imaging follow-up included head MRI,digital subtraction angiography(DSA),or CT angiography(CTA).Telephone follow-up was conducted for assessment of Karnofsky performance status score(KPS)and related neurological functions.Results All 5 patients underwent successful intracranial and extracranial revascularization of the anterior circulation.Total resection of the tumor on imaging was achieved in all 5 cases.Pathological results showed meningiomas in 4 cases and isolated fibrous tumors in 1 case.Postoperative review of cranial CTA results in all 5 patients suggested patency of the bridging vessels.Two patients with primary tumors developed postoperative damage of cranial nerveⅡ,Ⅲ,Ⅳ,andⅥon the affected side and 1 had dysfunction of cranial nerve V;One of the 3 patients with recurrent tumors had blindness in the affected eye.The median postoperative follow-up period was 3 years(1-5 years)for all 5 patients.Neurological deficits in the cavernous sinus improved in 4 patients during follow-up.Five patients had KPS scores of 60-70 at 1 month postoperatively and 80-90 at 12 months postoperatively.By th

关 键 词：颅窝 中 中枢神经系统肿瘤 脑血管重建术 神经外科手术 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]