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硬膜外入路处理中颅窝-海绵窦区三叉神经鞘瘤

Trans-extradural approach to resect trigeminal schwannomas involving the cavernous sinus region

摘要:

目的 探讨硬膜外入路切除中颅窝海绵窦区三叉神经鞘瘤的方法和疗效.方法 回顾性分析2008年10月至2012年1 1月采用硬膜外入路显微手术治疗海绵窦为主的三叉神经鞘瘤23例患者临床资料、手术方式、疗效和术后并发症情况.其中男性12例,女性11例;年龄26 ~ 63岁,平均46.2岁.23例患者均采用耳前颞下硬膜外入路,肿瘤向眶内生长的2例行额颞眶颧-硬膜外入路;其余病例均行颧弓-额颞硬膜外入路.术后3个月复查头颅MRI增强扫描,此后如果患者术中有肿瘤残留,每6个月随访复查1次,没有肿瘤残留的患者每8~12个月随访复查1次.结果 患者术后住院天数7~13d,平均8.5d.肿瘤2例来源于眼支,2例来源于上颌支,5例来源于下颌支,14例来源于半月节.肿瘤21例全切除,2例近全切除,全切除率91.3%.患者随访3个月至4年,中位随访时间19个月.术后面部麻木症状加重8例,好转10例;面部疼痛3例术后均好转;复视病例(外展神经麻痹5例,动眼神经麻痹1例)术后均好转;听力障碍1例好转,1例较术前加重.术后新发面部麻木2例,新发颞肌萎缩3例;1例患者2年后复发,行伽马刀治疗.本组无死亡病例.结论 硬膜外入路治疗海绵窦区神经鞘瘤手术损伤小、反应小、并发症少,有利于三叉神经、展神经、滑车神经、颈内动脉损伤的保护.

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abstracts:

Objective To investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.Methods Twenty-three patients (range 26-63 years,mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed.Frontotemporal orbitozygomatic extradural approach was performed in 2 patients.Frontotemporal zygomatic extradural approach was carried out in 21 patients.The first follow-up visit was on the 3rd month after surgery,and if residual was observed on enhanced MRI,then the patient was followed up every 6 months; otherwise,the patient was followed up every 8-12 months.Results The length of hospital stay after surgery was 7-13 days (mean 8.5 days).Two tumors originated from the ophthalmic branch,2 from the maxillary branch,5 from the mandibular branch and 14 from the gasserian ganglion.Total resection was achieved in 21 of the 23 patients(91.3%) and subtotal resection in the other 2 patients.All the patients were followed up from 3 months to 4 years.Median follow-up time was 19 months.The most common symptom was facial hypoesthesia,occurring in 18 patients.This symptom improved in 10 patients and worsened in 8 patients after surgery.New postoperative facial hypoesthesia was observed in 2 patients.Facial pain was observed in 3 patients and subsided after surgery.Two patients had loss of hearing,this symptom improved in 1 patient and worsened in 1 patient after surgery.Diplopia was observed in 6 patients.In 1 of these 6 patients,diplopia resulted from palsy of the oculomotor nerve.In the other 5 patients,diplopia resulted from palsy of the abducens nerve.This symptom improved postoperatively in all these 6 patients.New postoperative atrophy of the temporalis muscle was observed in 3 patients.There was no operation-related mortality.Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.Conclusions The middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus.This approach produces no further impairment,less complication,and is less likely to injured the trigeminal nerve,abducens nerve,trochlear nerve and internal carotid artery.

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作者: 冯世宇 [1] 卜博 [1] 余新光 [1] 陈晓雷 [1] 张艳阳 [1] 赵然 [2] 任贺成 [1] 孟祥辉 [1] 周涛 [1]
第一作者: 冯世宇
期刊: 《中华外科杂志》2013年51卷12期 1099-1103页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2013.12.010
发布时间: 2014-01-09
基金项目:
国家自然科学基金资助项目 首都临床特色应用研究重点资助项目
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