摘要
目的探讨颈静脉孔区脑神经鞘瘤的诊断和治疗。方法总结2001年11月至2005年6月手术治疗的11例颈静脉孔区脑神经鞘瘤,其中颅内型5例,颈静脉孔型3例,颈部型1例,混合型2例。手术方法包括迷路进路3例,乙状窦后进路2例,颞下窝进路6例。结果 11例手术均全切除肿瘤。术后无一例出现死亡、偏瘫、昏迷及颅内出血等严重并发症。2例乙状窦后进路患者术后听力仍部分保留。术中均保留面神经解剖完整性。面神经功能采用 House-Brackmann 分级,颅内型5例,术后Ⅰ级2例,Ⅱ级2例,Ⅳ级1例。颞下窝进路6例,术后Ⅰ级1例,Ⅲ级1例,Ⅳ级2例,Ⅴ级2例;其中面神经功能Ⅰ级者术中未行面神经移位。术前后组颅神经障碍者9例,术后后组颅神经障碍者11例。吞咽功能出院前完全代偿者7例,基本代偿者1例,部分代偿者2例,失代偿者1例;术后6个月除1例失代偿者仍需长期软食,部分代偿外,其余10例均能正常饮食。11例患者术后均出现声嘶,术后6个月,声嘶均好转。术后有2例患者出现脑脊液漏,表现为切口处皮下积液,均经局部加压包扎后好转,其中1例手术后2个月再次出现脑脊液漏,经局部麻醉下漏口修补后治愈。11例患者均未出现颅内感染。结论颈静脉孔区脑神经鞘瘤手术效果好,依据磁共振成像检查对肿瘤分型采取不同的手术方法。对颅神经功能的保护和锻炼是治疗的重点。
Objective To investigate the diagnosis and surgical treatment of lower cranial schwannomas of jugular foramen. Methods Retrospective review of 11 cranial schwannomas of jugular foramen which received surgical removal from November 2001 to June 2005. According to classification, 5 cases were as intracranial type, 3 as jugular foramen type, 1 as neck extension type and the other 2 as combination type. Surgical procedures composed of 3 translabyrinthine, 2 retrosigmoid and 6 subtemporal fossa approach. Results One-stage total tumor removal was accomplished in all the cases without any severe complications. Residue hearing was preserved in two cases received retrosigmoid approach. Anatomic completion of facial nerve was maintained in all the cases.Lower cranial neuropathy was found in 9 cases before surgery and occurred in all the cases after surgery. During in-hospital period complete compensation of swallowing ability was gained in 7 cases, near total, partial compensation and total decompensation was found in 1, 2 and 1 cases, respectively. Followed-up for 6 months, 10 cases caught normal swallowing function while the other one with partial compensation. Hoarseness was occurred in all the cases immediately after surgery and improved during follow-up. CSF leakage was occurred in 2 cases, no intracranial infection was found in all the cases. Conclusions Surgical treatment was the optimal management to cranial schwannoma of jugular foramen. Surgical approach selections depends on tunor classification on magnetic resonance imaging features. Nerve protection in surgery and postoperative rehabilitation were the key to better prognosis.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2007年第1期38-41,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
神经鞘瘤
中枢神经系统
颈静脉
手术中并发症
手术后并发症
Neurilemmoma
Central nervous system
Jugular veins
Intraoperative complication
Postoperative complication
