前外侧入路切除15例颈静脉孔区神经鞘瘤临床分析  

Resection of 15 patients with jugular foramen schwannomas via anterolateral approach

作　　者：刁玉领[1] 徐大伟[1] 常海刚[1] 李富光 周文科[1] Diao Yuling;Xu Dawei;Chang Haigang;Li Fuguang;Zhou Wenke(Department of Neurosurgery,First Affiliated Hospital of Xinxiang Medical College,Weihui 453100,China)

机构地区：[1]新乡医学院第一附属医院神经外科,卫辉453100

出　　处：《中华神经医学杂志》2023年第5期489-493,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨前外侧入路切除颈静脉孔区神经鞘瘤的可行性及临床疗效。方法回顾性收集新乡医学院第一附属医院神经外科自2018年1月至2022年7月收治的15例颈静脉孔区神经鞘瘤患者的临床资料,其中Samii分型B型3例、C型7例、D型5例。所有患者均采用前外侧入路手术切除肿瘤,术后通过门诊复查或电话、微信等方式规律随访,评估患者的肿瘤进展情况和神经功能状况。结果15例患者均获得良好的手术显露,其中肿瘤全切除14例,大部切除1例;术后1例后组颅神经麻痹加重,1例新发面瘫(House-Brackmann分级Ⅲ级),无脑脊液漏及皮下积液等并发症发生,无一例死亡。随访3个月时术后发生后组颅神经麻痹加重患者的饮水呛咳、吞咽困难症状消失或减轻,但声音嘶哑至6个月时仍未见明显改善;新发面瘫患者术后3个月时面神经功能恢复至House-Brackmann分级Ⅰ级。截至末次随访时,15例患者均未见肿瘤复发。结论采用前外侧入路均能满足不同Samii分型颈静脉孔区神经鞘瘤手术通道的显露需求,肿瘤全切除率高,术后并发症少。Objective To explore the feasibility and clinical efficacy of resection of jugular foramen schwannomas via anterolateral approach.Methods A retrospective analysis was conducted on clinical data of 15 patients with jugular foramen schwannomas admitted to Department of Neurosurgery,First Affiliated Hospital of Xinxiang Medical College from January 2018 to July 2022.Three patients had Samii type B,7 had type C and 5 had type D.Resection of the schwannomas was performed via anterolateral approach.After surgery,regular follow-up was performed through outpatient review,telephone,or WeChat to evaluate tumor progression and neurological functions.Results Adequate surgical exposure was obtained in all 15 patients.Total resection was obtained in 14 patients and subtotal resection in 1 patient.Posterior cranial nerve palsy was worsened in 1 patient and new-onset facial paralysis(House-Brackmann gradingⅢ)was noted in 1 patient,without cerebrospinal fluid leakage,subcutaneous effusion or death.Choking and cough during drinking water,and dysphagia disappeared or relieved 3 months after surgery in patients with aggravated posterior cranial nerve palsy,but no significant recovery from hoarseness was noted 6 months after surgery.A patient with new-onset facial paralysis improved to House-Brackmann grading I 3 months after surgery.Up to the last follow-up,no tumor recurrence was observed in 15 patients.Conclusion Resection via anterolateral approach is effective in jugular foramen schwannomas for its adequate surgical exposure,high total resection rate,and low postoperative complications.

关 键 词：神经鞘瘤 颈静脉孔区 前外侧入路 

分 类 号：R739.4[医药卫生—肿瘤]