内镜经鼻切除三叉神经鞘瘤的手术入路和临床疗效  

Surgical approaches and clinical outcomes of endoscopic endonasal resection for trigeminal schwannomas

作　　者：潘来胜 吴虓 唐斌[1] 谢申浩 肖利民[1] 吴博文 陈玉星 洪涛[1] PAN Laisheng;WU Xiao;TANG Bin;XIE Shenhao;XIAO Limin;WU Bowen;CHEN Yuxing;HONG Tao(Department of Neurosurgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院神经外科,南昌330006

出　　处：《中华显微外科杂志》2023年第5期563-569,共7页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(82201271);江西省自然科学基金(20232BAB216057)。

摘　　要：目的探讨内镜经鼻入路(EEA)切除三叉神经鞘瘤(TSs)的手术入路和临床疗效。方法回顾性分析2013年1月至2022年10月在南昌大学第一附属医院神经外科通过EEA治疗的41例TSs患者的临床资料、手术录像和门诊随访记录。男19例,女22例,平均年龄45.3(22~63)岁,其中左侧24例,右侧17例。根据Jeong的分型方法,对于6例MP型TSs,2例使用经Meckel腔入路(TMCA),其余4例联合经斜坡入路(TCA)切除;4例颞下窝受累患者(2例E3型、1例mE3型和1例Mpe3型)采用经泪前隐窝入路(TPRA),其中Mpe3型患者还联合了TMCA;2例E1型肿瘤患者均采用经眶纸板入路(TLPA)切除;其余29例,包括15例M型、10例Mp型、1例ME2型、2例E2型和1例MpE2型均采用单独TMCA入路。40例(97.6%)肿瘤获得全切除,仅有1例(2.4%)次全切除。结果共有40例患者有长期随访记录,1例失访,平均随访34(3~101)个月,未观察到肿瘤复发或进展。34例(89.5%)患者的术前症状得以改善,主要症状改善率如下:面部麻木(78.9%)、面部疼痛(70.0%)、头痛(88.2%)、咀嚼无力(50.0%)、视力下降(60.0%)、复视(83.3%)、展神经麻痹(100%)。本组分别有8例(19.5%)和9例(22.0%)患者出现短暂性和永久性神经功能障碍,除此之外,各有1例患者出现脑脊液漏和颈内动脉损伤。结论根据肿瘤所在位置选择对应的EEA,除主体位于后颅窝的TSs外,其他类型的肿瘤均可经EEA获得令人满意的结果。Objective To investigate the surgical approaches and clinical outcomes of endoscopic endonasal approaches(EEA)for trigeminal schwannomas(TSs).Methods Clinical data,surgical videos and outpatient follow-up notes of 41 patients with TSs and underwent EEA between January 2013 to October 2022 in the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University were retrospectively studied.The patients were 19 males and 22 females,with an average age of 45.3(22-63)years old.Twenty-four patients had TSs on the left and 17 on the right.According to Jeong's classification,for 6 TSs with type MP,2 tumours were resected by trans-Meckel's cave approach(TMCA)alone,and the remaining 4 TSs were resected by combined transclival approach(TCA).For the 4 tumours that involved infratemporal fossa(2 of type E3,1 of type mE3 and 1 of type Mpe3),the surgery were performed via a trans-prelacrimal recess approach(TPRA),of which the operation for type Mpe3 was combined with a TMCA.The trans-laminal papyracea approach(TLPA)was applied to remove 2 tumours of type E1.The rest of 29 patients received the surgery by TMCA alone to remove tumours including 15 of types M,10 of type Mp,1 of type ME2,2 of type E2 and 1 of type MpE2.Gross total tumour resection was achieved in 40 patients(97.6%),with only 1 patient(2.4%)had a subtotal tumour resection.Results A total of 40 patients had completed the long-term follow-up,with 1 patient lost in follow-up.The average follow-up period was 34(3-101)months;No tumour recurrence or progression was observed over follow-up.After the surgery,preoperative symptoms were improved in 34 patients(89.5%).The main improved symptoms were:facial numbness(78.9%),facial pain(70.0%),headache(88.2%),mastication weakness(50.0%),poor vision(60.0%),diplopia(83.3%),and abducens nerve palsy(100%).Transient and permanent neurological deficits occurred in 8(19.5%)and 9(22.0%)patients,respectively.Cerebrospinal fluid leakage and internal carotid artery injury occurred in 1 patient each.Conclusion According to

关 键 词：三叉神经鞘瘤 神经内镜 手术入路 显微外科技术 

分 类 号：R739.4[医药卫生—肿瘤]