枕下极外侧髁上入路处理颈静脉孔区肿瘤

目的探讨枕下极外侧髁上入路手术切除颈静脉孔区肿瘤的临床价值及适用范围。方法分析75例枕下极外侧髁上入路手术的颈静脉孔区肿瘤患者的资料。其中神经鞘瘤28例,副神经节瘤25例,脑膜瘤11例,脊索瘤7例,软骨肉瘤4例。根据肿瘤的生长方向和大小范围,使用拐杖形切口者42例,围绕耳廓下颌角的弧形切口者33例。每例患者在枕骨髁上方磨开颈静脉孔,切除孔内外的肿瘤。结果肿瘤手术全切除51例;近全切除17例;次全切除7例。术后5例患者发生脑脊液漏。术中脑神经功能监测有利于后组脑神经的解剖保留。33例患者未新增脑神经损害症状。术后随访3~24个月,16例患者存在轻度饮水呛咳、声音嘶哑但无吞咽困难;无永久带气管插管或胃管的患者。结论该入路显露充分,无需过多磨除岩骨及轮廓化面神经管,对寰枕关节的稳定性影响较小,适于切除主体在颈静脉孔区和向颅内及颅颈交界部扩展的肿瘤。

Resections for jugular foramen tumors through far lateral suboccipital supracondyle approach

Objective To explore the clinical value and applicability of resections for jugular foramen tumors through far lateral suboccipital supracondyle approach .Methods The clinical data of 75 patients with jugular foramen tumors operated by far lateral suboccipital supracondyle approach were analyzed .Of 75 patients , 28 were shwannomas , 25 paragangliomas , 11 meningiomas , 7 chordomas and 4 chondrosarcomas .The incision depended on the tumor extension direction and tumor size.Among the 75 cases, hook-shaped incisions were chosen in 42, curvilinear incisions were selected in 33 .The vertebral artery and occipito-atlas joint were exhibited and jugular foramen was opened from supracondyle direction .Results Of 75 patients,51 received total resection of the tumors,17 subtotal resection and 7 partial resection.Postoperative CSF leakage occurred in 5 cases. The patients were followed up from 3 to 24 months.Intraoperative neurophysiologic monitoring was beneficial to preservation of residual caudal cranial nerves .33 cases had no newly-developed cranial nerve dysfunctions .16 patients presented with slight hoarse and no dysphasia at the time of follow-up at least 3 months later .None permanent placement of gastro or tracheal tube .Conclusions The approach was performed without much more resection of petrous bone and skeletonization of facial nerve .We can get an extensive exposure without worsen the stability of crania-vertebral junction .The key of operation is to demonstrate different anatomy corridor according to the size and orientation of individual tumors .This approach is apt for the tumors with their main part within jugular foreman and extending to posterior fossa or craniocervical junction .