咽鼓管上三角在扩大经鼻蝶入路神经内镜手术切除岩尖下区肿瘤中的意义  

Clinical significance of supra-eustachian triangle in endoscopic resection through expanded transnasal approach for inferior petrous apex tumors

作　　者：冯文献 杨扬 王纵 FENF Wen-xian;YANG Yang;WANG Zong(Department of Neurosurgery,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]驻马店市中心医院神经外科,河南463000

出　　处：《中国临床神经外科杂志》2022年第5期349-352,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨咽鼓管上三角(SET)在扩大经鼻蝶入路神经内镜手术切除岩尖下区肿瘤中的意义。方法 回顾性分析2017年1月至2021年8月扩大经鼻蝶入路神经内镜手术切除的13例岩尖下区肿瘤的临床资料。连接骨性咽鼓管内侧与咽鼓管圆枕顶部的水平线定义为SET,颈内动脉岩骨段水平部和咽鼓管与水平线的倾斜角度分别定义为角α和角β。根据术前MRI增强影像评估肿瘤向两侧扩展程度,分为重度、中度、轻度扩展。结果 术后病理检查显示脊索瘤8例,软骨肉瘤3例,脑膜瘤2例。肿瘤全切除6例(46.2%),次全切除3例,部分切除4例。术后发生脑脊液漏2例、外展神经麻痹2例,未发颈内动脉损伤。术后随访6-36个月,2例复发,再次手术,无死亡病例。定量测量13例26侧SET的面积在28.0-95.2 mm^(2),平均(65.6±22.2)mm^(2)。8侧重度扩展SET面积[(76.5±27.6)mm^(2)]较10侧中度扩展侧SET面积[(42.2±15.7)mm^(2)]和8侧轻度扩展SET面积[(40.5±10.7)mm^(2)]明显扩大(P<0.001),中度扩展和轻度扩展侧SET面积无显著差异(P>0.05)。10侧重度扩展中,肿瘤全切除或次全切除侧SET较部分切除侧明显增大(P<0.05);肿瘤全切除或次全切除侧角α[(0.40±0.05)°]明显大于部分切除侧[(0.15±0.03)°;P<0.01],而角β无明显差异[(0.25±0.04)°vs.(0.21±0.06)°;P>0.05]。角α与SET面积呈显著正相关(r=0.580;P<0.001)。结论 扩大经鼻蝶入路神经内镜手术切除岩尖下区肿瘤是可行的,SET面积是评估肿瘤可切除性的有效指标,特别肿瘤重度扩展时。Objective To explore the clinical significance of supra-eustachian triangle(SET) in the endoscopic resection through expanded transnasal approach for inferior petrous apex tumors. Methods A retrospective analysis was performed on the clinical data of 13 patients with inferior petrous apex tumor who underwent endoscopic resection through expanded transnasal approach from January 2017 to August 2021. The SET area was estimated using the horizontal line connecting the medial side of the bone eustachian tube and the top of the round pillow of the eustachian tube, and the inclination angles of the level part of internal carotid artery(ICA) petrosal segment and eustachian tube relative to the horizontal line were defined as angles α and angle β, respectively. The preoperative MRIenhanced images were used to evaluate the extent of tumor extension, including severe, moderate and mild extension. Results Postoperative pathological examination showed chordoma in 8 patients, chondrosarcoma in 3, and meningioma in 2. Total tumor resection was achieved in 6 patients(46.2%), subtotal in 3, and partial in 4. Postoperative cerebrospinal fluid leakage occurred in 2 patients, and abducens nerve palsy in 2. There was no ICA injury. Follow-up(range, 6~36 months) showed recurrence in 2 patients undergoing reoperation. The area of SET on 26 sides of 13 patients ranged from 28.0 mm^(2)to 95.2 mm^(2), with an average of(65.6±22.2) mm^(2). The area of SET of 8 sides with severe extension [(76.5±27.6) mm^(2)] was significantly larger than that [(42.2±22.2) mm^(2)] of 10 sides with moderate extension(P<0.001) and that [(40.5±10.7) mm^(2)] of 8 sides with mild extension(P<0.001). In the 10-side severe extension, the SET area and the angle α of total tumor resection or subtotal resection were significantly larger than those of tumor partial resection(P<0.05),while there was no significant difference in angle β(P>0.05). Angle α was significantly positively correlated with the SET area(r=0.580;P<0.001). Conclusions The endoscopic resec

关 键 词：颅内肿瘤 岩尖下区肿瘤 咽鼓管上三角 扩大经鼻蝶入路 神经内镜手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]