颞下硬膜外入路手术切除哑铃状三叉神经鞘瘤  

Anatomy,techniques and outcomes of microsurgery via infratemporal epidural approach for dumbbell-shaped trigeminal schwannomas

作　　者：李俊卿[1] 马小二[1] 薛俊锋[1] 杨孔宾 LI Jun-qing;MA Xiao-er;XUE Jun-feng;YANG Kong-bin(Department of Neurosurgery,Jiaozuo People's Hospital,Jiaozuo 454000,China;Department of Neurosurgery,Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510700,China)

机构地区：[1]焦作市人民医院神经外科,河南454000 [2]广州医科大学附属第五医院神经外科,广州510700

出　　处：《中国临床神经外科杂志》2024年第11期650-654,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颞下硬膜外入路的手术解剖、手术技巧及治疗哑铃状三叉神经鞘瘤的效果。方法取8具10%甲醛溶液处理的成人尸头标本,经颞下硬膜外入路暴露Meckel腔、海绵窦区及三叉神经根部,对相关解剖标志进行测量。回顾性分析2010年至2020年颞下硬膜外入路手术治疗的15例哑铃状三叉神经鞘瘤的临床资料,总结手术经验。结果尸头解剖研究显示,颞下硬膜外入路能够充分暴露三叉神经根部,前内侧三角和滑车上三角的面积分别为(52.4±13.1)mm~2、(27.4±6.3)mm~2。15例哑铃状三叉神经鞘瘤术后复查MRI显示肿瘤全切除13例,全切率为87%;次全切除2例(13%);术后随访6个月,11例(73.3%)症状缓解或保持原状,4例出现新的神经功能障碍。术后5例出现多种并发症,都存在颅神经损伤。结论颞下硬膜外入路切除哑铃状三叉神经鞘瘤具有一定优势,但仍存在较高的并发症风险。需要进一步优化手术技巧,平衡肿瘤切除程度与神经功能保护,以改善手术效果。Objective To investigate the anatomy,techniques,and efficacy of microsurgery via infratemporal epidural approach for dumbbell-shaped trigeminal schwannomas.Methods Eight cadaveric head specimens were dissected using the infratemporal epidural approach to expose the Meckel's cave,cavernous sinus,and trigeminal nerve root,and relevant anatomical landmarks were measured.Additionally,a retrospective analysis was conducted on the clinical data of 15 patients with dumbbell-shaped trigeminal schwannoma who underwent resection through infratemporal epidural approach between 2010 and 2020,summarizing the surgical experience.Results Cadaveric dissection revealed that the infratemporal epidural approach provided excellent exposure of the trigeminal nerve root;the anteromedial triangle and supraorbital triangle had relatively small areas of(52.4±13.1)mm2 and(27.4±6.3)mm2,respectively.The postoperative MRI reexaminations of 15 patients with dumbbell-shaped trigeminal schwannomas showed that complete tumor resection was accomplished in 13 patients(87%),and subtotal resection was carried out in 2(13%).Of the 15 patients followed up for 6 months postoperatively,11 patients(73.3%)experienced symptom relief or stabilization,while 4 developed new neurological deficits.Postoperative complications occurred in 5 patients,all involving cranial nerve injury.Conclusions The infratemporal epidural approach offers certain advantages for resecting dumbbell-shaped trigeminal schwannomas but carries a relatively high risk of complications.Further optimization of surgical techniques is necessary to balance tumor resection and neural function preservation,thereby improving surgical outcomes.

关 键 词：哑铃状三叉神经鞘瘤 颞下硬膜外入路 显微手术 尸头解剖 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]