桥小脑角肿瘤继发性三叉神经痛的临床病理特征  

Clinicopathological characteristics of secondary trigeminal neuralgia due to cerebellopontine angle tumors

作　　者：王颖[1,2] 刘瑞洁[2] 杨治权 杨转移[3] WANG Ying;LIU Ruijie;YANG Zhiquan;YANG Zhuanyi(Department of Pathology,School of Basic Medical Science,Central South University,Changsha 410013;Department of Pathology,Xiangya Hospital,Central South University,Changsha 410008;Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学基础医学院病理学系,长沙410013 [2]中南大学湘雅医院病理科,长沙410008 [3]中南大学湘雅医院神经外科,长沙410008

出　　处：《中南大学学报（医学版）》2024年第4期588-594,共7页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2022JJ30978);湖南省本科生教改项目(HNJG-2022-0449);中南大学研究生案例库建设(2022ALK024)。

摘　　要：目的:桥小脑角(cerebellopontine angle,CPA)肿瘤是继发性三叉神经痛(trigeminal neuralgia,TN)的常见病因,其位置隐蔽,进展缓慢,难以早期发现。本研究旨在探讨CPA肿瘤继发性TN患者的临床病理特征,提高对继发性TN诊治的认识。方法:回顾性分析中南大学湘雅医院2017年1月1日至2022年12月31日收治的116例CPA肿瘤继发TN患者的临床资料和病理结果,分析肿瘤病理类型与临床表现、肿瘤部位、手术方式及疗效的关系。结果:本组病例中95.7%(111/116)为良性肿瘤,3.4%(4/116)为恶性肿瘤,0.9%(1/116)为交界性肿瘤,良性肿瘤以胆脂瘤、脑膜瘤、神经鞘瘤多见。46.6%(54/116)的患者表现为单纯TN,53.4%(62/116)出现其他伴随症状,这取决于不同类型肿瘤的生长部位、生长速度等因素。本组病例手术全切率在90%以上,41.4%(48/116)的患者在切除肿瘤后同期行微血管减压,其中神经鞘瘤占比最高。手术治疗总体有效率达93.9%,神经鞘瘤的有效率高于胆脂瘤、脑膜瘤(均P<0.05);胆脂瘤的复发率显著高于脑膜瘤、神经鞘瘤(均P<0.05)。结论:CPA肿瘤是继发性TN的主要病因,以良性肿瘤多见,恶性肿瘤虽少但容易被漏诊,早期诊治对预后影响很大。不同类型肿瘤在临床症状、手术方式、疗效等方面有所不同,手术策略需兼顾肿瘤切除程度及神经功能保护,必要时行微血管减压术。Objective:Cerebellopontine angle(CPA)tumors are a common cause of secondary trigeminal neuralgia(TN),characterized by their concealed location,slow progression,and difficulty in early detection.This study aims to explore the clinicopathological characteristics of patients with secondary TN due to CPA tumors to enhance understanding and management of secondary TN.Methods:A retrospective analysis was conducted on clinical data and pathological results of 116 patients with CPA tumor-related TN treated at Xiangya Hospital of Central South University from January 1,2017 to December 31,2022.The study analyzed the relationship of tumor pathological types with clinical manifestations,tumor location,surgical methods,and treatment outcomes.Results:Among the cases,95.7%(111/116)were benign tumors,3.4%(4/116)were malignant tumors,and 0.9%(1/116)were borderline tumors.Benign tumors were predominantly acoustic neuromas,meningiomas,and schwannomas.Among the patients,46.6%(54/116)presented with isolated TN,while 53.4%(62/116)exhibited other associated symptoms depending on factors such as tumor growth location and rate.The complete resection rate in this group was over 90%,with 41.4%(48/116)of patients undergoing concurrent microvascular decompression after tumor resection,predominantly for schwannomas.The overall effective rate of surgical treatment reached 93.9%,with schwannomas showing higher efficacy rates compared with acoustic neuromas and meningiomas(P<0.05).The recurrence rate of acoustic neuromas was significantly higher than that of meningiomas and schwannomas(P<0.05).Conclusion:CPA tumors are a major cause of secondary TN,predominantly benign,with occasional underdiagnosed malignant tumors.Early diagnosis and treatment significantly impact prognosis.Different tumor types vary in clinical symptoms,surgical approaches,and treatment efficacy.Surgical strategies should balance tumor resection extent and neural function preservation,with microvascular decompression as necessary.

关 键 词：继发性三叉神经痛 桥小脑肿瘤 临床病理分析 

分 类 号：R739.41[医药卫生—肿瘤] R745.11[医药卫生—临床医学]