颈静脉孔区肿瘤术后后组脑神经损伤的评估和处理

目的：分析颈静脉孔区肿瘤术后后组脑神经损伤情况及其处理,以提高对后组脑神经损伤的认识并改进处理方法。方法：32例颈静脉孔区肿瘤患者中,颈静脉球体瘤12例,后组脑神经鞘膜瘤10例,脑膜瘤3例,胆脂瘤1例,颞骨巨细胞瘤2例,纤维瘤病1例,黏液软骨肉瘤1例,胚胎型横纹肌肉瘤1例,腺样囊性癌1例。均采取手术治疗,30例全切,1例近全切,1例大部切除。结果：除1例术后并发颅内出血死亡外,其余31例术后随访1-6年。术后后组脑神经功能仍正常者5例,新出现神经功能损伤者8例,原有神经功能损伤者18例术后出现不同程度的损伤加剧表现。手术前后行气管切开者8例,其中3例出院前拔管,5例带管出院。出院时后组脑神经损伤代偿者20例,失代偿者6例。失代偿者术后随访中3例代偿,2例部分代偿,1例未代偿。结论：颈静脉孔区肿瘤术后后组脑神经损伤是常见并发症,术前应根据患者年龄、神经功能等综合评估,术中应尽量保全神经,早期积极正确的功能锻炼是术后处理的关键。

Functional evaluation and management of lower cranial nerve injuring after jugular foramen tumor surgery

Objective:To evaluate the injuring and rehabilitation of lower cranial nerve after surgery of jugular foramen tumors.Method:The lower cranial nerve functions were analyzed retrospectively in 32 cases with jugular foramen tumors in the past six years,including 12 jugular glomus, 10 schwannomas, three meningiomas, one cholesteatoma,two giant cell tumors,one fibromatosis,one chondromyxosarcoma,one adenoid cystic carcinoma and one embryonal rhabdomyosarcoma. All patients received surgical procedures.Total tumor removal was achieved in 30 cases, subtotal and partial resection were performed on one case respectively.Result:One case was died of intracranial bleeding after surgery, the other 31 were followed-up with a period from one to six years. Normal lower nerve functions were observed in five cases and new nerve deficits were observed in eight cases. Eighteen cases with poor nerve functions before surgery experienced additional nerve injuring manifestations. Eight cases received tracheoto-my in perisurgical period, in which three were transient and five went home with tubes.Twenty cases were compensated well after a short period,and six cases failed to compensate. With a long-term follow-up for these six patients, three cases had well functional rehabilitation, two were partially compensated, and one was decompensated.Conclusion:Lower cranial nerve dysfunction was the most common complication after jugular foramen tumor surgery. Preoperative nerve function evaluations, protection of nerve during surgery and early postoperative functional rehabilitation training were the key to better prognosis.