向颅内扩展巨型鼻咽血管纤维瘤的围手术期处理

目的:总结8例向颅内扩展的巨型鼻咽血管纤维瘤(JNA)患者手术成败的经验教训,提出围手术期处理应注意的事项.方法:8例男性患者,均为分别侵入前和(或)中颅窝的巨型JNA,其中颈内动脉颅内段参与肿瘤供血者4例,复发再次手术3例.术前均酌情选用CT、CT血管造影、MRI和(或)磁共振血管造影进行影像学评估;DSA技术检测肿瘤供血范围.并超选择性栓塞瘤体供血.8例均采取颅面联合入路的方法.结果:5例完整切除,3例部分切除.3例未能全切的原因为:2例因早期未行DSA技术血管栓塞,术中出血过多而失败,1例因错估影像学检查而遗漏对侧蝶窦的肿瘤分叶.结论:得当的以手术为中心的围手术期处理是减少术中出血、彻底切除肿瘤,避免并发症的重要保障.

Perioperative managements of huge lobulated nasopharyngeal angiofibromas with intracranial extensions

Objective:To summarize our experience of successful and failed management in 8 huge lobulated nasopharyngeal angiofibromas with intracranial extensions,and introduce some key points of perioperative treatments.Method:Eight male case with an average age of 18 years,were all lobes extending into middle and/or anterior cranial fossa,in which 5 cases revealed blood supply from the internal carotid arteries and 3 cases were reoperated because of recurrence.Preoperatively,the tumor were evaluated by CT,CTA,MRI and /or MRA,and super selective embolization of the feeding arteries were crucial procedures.The combined craniofacial approaches were used to excise these tumors.Result:Five cases were removed completely,and 3 cases were removed partly in which 2 were due to serious bleeding casued by lack of DSA technique at that time and 1 were due to neglecting the tumor lobe in the sphenoid sinus of the other side.Conclusion:Reasonable perioperative management are very important for control of intra-operative blood loss,complete removaling of the tumor and avoiding complication.