小脑脑桥角区表皮样囊肿的手术疗效分析  

Analysis of the surgical effect of epidermoid cyst in the cerebellopontine angle

作　　者：杨宝慧 严忠辉 杨文桢[1] 史雪峰[1] 赵明睿 韩彦明[1] 张新定[1] Yang Baohui;Yan Zhonghui;Yang Wenzhen;Shi Xuefeng;Zhao Mingrui;Han Yanming;Zhang Xinding(Department of Neurosurgery,the Second Hospital of Lanzhou University,Laboratory of Neurosurgery,Institute of Neurology,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院神经外科,神经外科实验室,兰州大学神经病学研究所,兰州730000

出　　处：《中华神经外科杂志》2022年第10期1018-1021,共4页Chinese Journal of Neurosurgery

基　　金：兰州大学第二医院"萃英科技创新"临床拔尖技术研究(CY2019-BJ18, CY2018-BJ12)。

摘　　要：目的探讨小脑脑桥角(CPA)区表皮样囊肿的手术疗效。方法回顾性分析2014年6月至2020年6月兰州大学第二医院神经外科收治的50例CPA区表皮样囊肿患者的临床资料。其中表现为三叉神经痛43例、面肌痉挛4例、三叉神经痛合并面肌痉挛3例。所有患者接受枕下乙状窦后入路肿瘤切除术, 术中探查血管与脑神经的关系, 必要时行显微血管减压术(MVD)或神经部分离断术。术后3个月及之后每年进行电话及门诊随访, 随访患者的神经功能恢复情况以及有无肿瘤复发等。结果 50例患者均顺利完成肿瘤切除术, 5例患者同期行MVD, 1例患者同期行三叉神经部分离断术。肿瘤全切除31例, 次全切除9例, 大部切除10例。术后, 50例患者的术前症状均缓解, 18例出现新发脑神经功能障碍。术后出现颅内少量出血3例, 无菌性脑膜炎4例, 脑脊液漏1例, 口周疱疹1例。50例患者的中位随访时间为48个月(3~91个月)。随访期间, 3例患者症状复发, 其中2例肿瘤复发。至末次随访, 17例患者术后新发脑神经功能障碍完全缓解, 仅1例遗留面瘫。结论采用枕下乙状窦后入路切除CPA区表皮样囊肿, 同时选择性采用MVD或神经部分离断术, 术后疗效好、并发症较少。Objective To explore the surgical effect of epidermoid cyst in the cerebellopontine angle(CPA).Methods The clinical data of 50 patients with epidermoid cyst in the CPA region treated in the Department of Neurosurgery of the Second Hospital of Lanzhou University from June 2014 to June 2020 were analyzed retrospectively,including 43 cases of trigeminal neuralgia,4 cases of hemifacial spasm and 3 cases of trigeminal neuralgia complicated with hemifacial spasm.All patients underwent suboccipital retrosigmoid approach for tumor resection.The relationship between blood vessels and cranial nerves was explored during the operation,and microvascular decompression(MVD)or partial nerve dissection was performed when necessary.Telephone and outpatient follow-up were conducted 3 months after the operation and every year thereafter to follow up the patients′neurological recovery and whether there was tumor recurrence.Results All 50 patients successfully underwent tumor resection.Among them,5 patients underwent MVD at the same time,and 1 patient underwent partial dissection of trigeminal nerve at the same time.Total tumor resection was performed in 31 cases,subtotal resection in 9 cases,and partial resection in 10 cases.After operation,the preoperative symptoms of 50 patients were relieved,and 18 patients developed new cranial nerve dysfunction.There were 3 cases of small intracranial hemorrhage,4 cases of aseptic meningitis,1 case of cerebrospinal fluid leakage and 1 case of perioral herpes after operation.The median follow-up time of the 50 patients was 48 months(range:3-91 months).During the follow-up period,symptoms recurred in 3 patients,of which 2 had tumor recurrence.By the last follow-up,17 patients had completely relieved newly-developed cranial nerve dysfunction after operation,and only 1 patient had remaining facial paralysis.Conclusion Resection of CPA epidermoid cyst via suboccipital retrosigmoid approach,combined with selective MVD or partial nerve dissection,has a good postoperative effect and fewer postoperativ

关 键 词：小脑脑桥角 三叉神经 面神经 表皮样囊肿 显微外科手术 

分 类 号：R651.11[医药卫生—外科学]