颅底内淋巴囊肿瘤的临床特点及手术疗效观察  

Clinical characteristics and surgical outcome of skull base endolymphatic sac tumors

作　　者：李永[1] 康军[1] 赵尚峰[1] 孙博文 王卫[1] 杨本涛[2] 王杰[3] 马晓波[3] 陈树斌[3] 郝欣平[3] 李永新[3] Li Yong;Kang Jun;Zhao Shangfeng;Sun Bowen;Wang Wei;Yang Bentao;Wang Jie;Ma Xiaobo;Chen Shubin;Hao Xinping;Li Yongxin(Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Bejing 100730,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Bejing 100730,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Bejing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经外科,北京100730 [2]首都医科大学附属北京同仁医院影像科,北京100730 [3]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《中华神经外科杂志》2023年第6期577-582,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅底内淋巴囊肿瘤(ELST)的临床特点及手术疗效.方法回顾性分析2014年8月至2022年2月首都医科大学附属北京同仁医院神经外科联合耳鼻咽喉头颈外科手术治疗的7例ELST患者的临床资料.术前均经多学科讨论制定治疗方案.其中4例患者术前行供血动脉血管内栓塞;肿瘤最大径<3 cm的4例患者,采用经乳突入路;≥3 cm的3例患者,1例采用经颞下窝入路,2例采用经颞下窝入路联合中颅底入路或乙状窦后入路.结果4例患者首发症状表现为听力下降和耳鸣,1例合并von Hippel-Lindau病.术前面神经功能House-Brackmann分级Ⅰ级4例,Ⅱ级1例,Ⅳ级2例.CT主要表现为溶骨性骨质破坏;MRI表现为肿物呈囊实性,血供丰富.肿瘤最大径<3 cm的4例患者,全切除2例,次全切除1例,大部分切除1例;≥3 cm的3例患者,全切除1例,大部分切除2例.7例患者术后中位随访时间为48个月(2个月至6年).3例全切除及1例次全切除者均无肿瘤复发.2例肿瘤大部分切除者术后接受放疗,1例肿瘤消失,随访6年无复发;1例随访3年,肿瘤有缩小趋势.1例患者术后4年死于肿瘤进展,其余6例正常生活.结论ELST具有特征性影像学表现;多学科合作制定个体化手术治疗方案、术后残余肿瘤辅助放疗,均有助于提高患者的疗效.Objective To investigate the clinical characteristics and surgical outcome of skull base endolymphatic sac tumors(ELSTs).Methods A retrospective analysis was conducted on the clinical data of 7 patients with ELST's who underwent surgical treatment by the Department of Neurosurgery and Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University from August 2014 to February 2022.The treatment strategy was decided based on multidisciplinary team discussion before operation.Embolization of the feeding artery was performed in 4 patients.In 4 patients with the tumor maximum diameter<3 cm,transmastoid approach was taken.Out of 3 patients with the tumor maximum diameter≥3 cm,1 case underwent infratemporal fossa approach and 2 underwent infratemporal fossa approach combined with middle cranial fossa approach or retrosigmoid approach.Results The first symptoms of 4 patients were hearing loss and tinnitus.One patient had renal cell carcinoma and was diagnosed as von Hippel-Lindau disease.All patients had different degrees of hearing loss before operation.As for preoperative facial nerve function,there were 4 cases of House-Brackmann(H-B)gradeⅠ,1 case of H-B gradeⅡand 2 cases of H-B gradeⅣ.The imaging manifestation of CT was osteolytic bone destruction and MRI showed cystic and solid tumors with abundant blood supply.In 3 patients with the tumor size≥3 cm,total resection was performed in 1 case and gross total resection in 3 cases.In 4 patients with the tumor size<3 cm,total resection was performed in 2 cases,subtotal resection in 1 case and gross resection in 1 case.The median follow-up time for all patients after operation was 48 months(2 months to6 years).There was no tumor recurrence in 3 patients receiving total or 1 patient receiving subtotal resection.Out of 2 patients with gross total resection received postoperative radiotherapy,1 had tumor that disappeared and was followed up for 6 years without recurrence;one was followed-up for 3 years with a trend of tumor shr

关 键 词：内淋巴囊 肿瘤 疾病特征 外科手术 治疗结果 

分 类 号：R739.41[医药卫生—肿瘤]