颅眶沟通瘤的诊断与显微外科手术治疗

对38例颅眶沟通瘤诊断与手术治疗进行回顾性研究，以期进一步提高此类肿瘤的疗效，全组38例，其中男29例，女9例，年龄4－54岁，平均32.2岁，肿瘤在颅内位于前颅凹33例，中颅凹5例，35例（92.1%)出现与视器有关的症状，23例（60.5%)有头痛，头晕等颅内压增高症状。部分病例行血管造影及术前颈外供瘤血管栓塞术。采用显微外科技术与不同手术入路切除肿瘤，全切者28例，大部切除者10例，均恢复良好，术后无死亡。随访7个月－9年，24例完全恢复健康，6例生活需要照顾，5例有不同程度恢复，3例恶性肿瘤在术后3个月－2年死于多器官功能衰竭。颅眶沟通瘤多以视器改变为主要临床表现，对颅眶沟通的高血运肿瘤，术前栓塞可以明显地减少手术中出血，增加全切除肿瘤的可能性；采用不同手术入路及多学科联合，在显微镜下切除肿瘤，可直接改善手术治疗的效果。     

内侧型蝶骨嵴脑膜瘤的显微手术治疗

目的探讨内侧型蝶骨嵴脑膜瘤的显微手术方法及技巧。方法回顾性分析2005年1月-2010年1月收治的内侧型蝶骨嵴脑膜瘤患者29例,男13例,女16例,年龄18～68岁,平均42岁,病程5个月～8年,平均28个月。采用显微神经外科手术治疗,术中对肿瘤与周围重要结构的关系进行评估,通过离断肿瘤供应血管、缩小肿瘤体积、分离肿瘤与毗邻血管及神经间隙等方法,最终彻底切除肿瘤。术后随访6个月～4年。结果肿瘤全切20例,次全切7例,部分切除2例。术前视力明显减退的20例患者,术后12例明显好转,6例无改善,2例恶化。术后2例不全偏瘫,6例动眼神经麻痹,全部患者无死亡。术后随访6个月～4年,肿瘤切除程度SimpsonⅠ、Ⅱ级者(共27例)术后未见复发,SimpsonⅢ级者(2例)切除后均行放疗或γ刀治疗,其中1例复发,再次行手术治疗。结论术中精细评估肿瘤与毗邻重要结构的关系,根据评估结果指导分离、切除肿瘤是内侧型蝶骨嵴脑膜瘤彻底切除的关键,且积极切除肿瘤对恢复视力及控制肿瘤有利。     

显微外科手术治疗颅咽管瘤95例预后分析

目的探讨颅咽管瘤显微手术治疗的方法选择及影响患者预后的相关因素。方法回顾性分析2008年1月至2013年6月中国医科大学附属第一医院收治的95例颅咽管瘤患者临床资料,均行显微外科手术治疗。随访并评估生存质量。结果肿瘤全切除70例,次全切除15例,部分切除10例。最常见的术后并发症为垂体功能低下及尿崩。术后随访8个月至5年,死亡16例(16.8%),复发14例。性别和切除程度是影响术后5年生存率的危险因素。结论采用显微外科手术全切颅咽管瘤,5年生存率较高,且复发率较低。     

显微外科手术治疗颅咽管瘤46例分析

目的探讨颅咽管瘤显微手术切除的方法和效果。方法采用显微外科手术治疗颅咽管瘤46例。术前对临床表现、影像检查进行分析,经额下或翼点入路进行手术。结果全切除18例,次全切除28例,无手术死亡。术后临床症状和体征均有不同程度的恢复。结论采用显微手术治疗颅咽管瘤,可以提高肿瘤本身和肿瘤壁的全切除率,达到保护视力,改善内分泌功能,减少各种并发症的目的。首次手术应尽量全切。     

垂体腺瘤侵犯海绵窦

直接侵犯邻近软组织和骨结构的垂体瘤称“侵袭性垂体腺瘤”。穿透侵入海绵窦的垂体瘤难以完全切除,并给手术治疗带来较大的危险性。因而术前证实海绵窦受侵可有助于为病人制订适当的手术及药物治疗方案。作者对198例垂体瘤病人中,CT显示有海绵窦直接受累且手术证实的19例病人进行了分析。病人用高分辨CT机,5或3mm层厚,冠状面和/或横断面,在快速滴注造影剂之后进行扫描。作者指出,海绵窦受侵犯的CT表现为:海绵窦扩大(17例);颈内动脉被包绕(14例);海绵窦内颅神经受压消失或移位(14例);海绵窦侧壁受累(7例);弥漫性骨破坏(7例)。可见到侵犯肿瘤的强化程度常低于海绵窦和同侧的颈内动     

显微手术切除枕骨大孔区神经鞘瘤18例报告

显微手术切除枕骨大孔区神经鞘瘤１８例报告武警总医院神经外科杜长生张蕴增刘勇刘雪飞唐红李钟铬（北京１０００３９）关键词显微手术枕骨大孔神经鞘瘤我院自１９９２年２月～１９９６年２月共收治枕骨大孔区神经鞘瘤１８例，经显微手术切除并经病理诊断，治疗效果满意。...     

神经导航显微手术联合光动力疗法治疗功能区脑胶质瘤

目的探讨神经导航显微手术联合光动力疗法（PDT）治疗功能区脑胶质瘤的安全性及有效性。方法将65例功能区胶质瘤患者分为两组,治疗组40例经神经导航指引下进行显微手术切除病灶,然后根据瘤床的结构和形状对瘤腔进行PDT治疗;对照组25例单纯行神经导航显微手术切除病灶。治疗后第8周和第12周行CT、MRI检查观察两组患者术后肿瘤坏死、水肿带减轻、残留肿瘤体积等变化,并观察神经功能缺失情况。结果治疗后8周和12周治疗组和对照组出现新的神经功能缺失率分别为2.5%、5.0%和7.5%、12.0%。影像学显示治疗组肿瘤坏死,水肿带减轻31例,8例残留肿瘤体积明显缩小;对照组水肿带减轻15例,4例术后残留肿瘤体积无变化。结论神经导航显微手术联合PDT疗法治疗功能区脑胶质瘤,能够有效抑制肿瘤生长,并能使残留肿瘤体积缩小,减少神经功能缺失,在减缓出现新的神经功能缺失和改善患者生活质量方面具有一定优势。     

内侧型蝶骨嵴脑膜瘤的显微外科治疗

目的 提高内侧型蝶骨嵴脑膜瘤的全切率,降低病死率和致残率.方法 对25例内侧型蝶骨嵴脑膜瘤显微外科治疗病例的临床资料进行回顾性分析.结果 冠状位计算机体层摄影术有助于判断肿瘤的生长点.磁共振成像可显示肿瘤与海绵窦、颈内动脉的关系.1例肿瘤侵入海绵窦,11例肿瘤包绕颈内动脉和主要分支.肿瘤附着点为前床突和(或)小翼的内侧.18例达Simpson Ⅰ、Ⅱ级全切除.无手术死亡,疗效满意.结论 显微手术可明显提高肿瘤全切率,减少术后并发症,降低病死率.手术要点是尽早离断肿瘤基底并沿颈内动脉床突上段由近向远分离切除包绕的肿瘤.由于多数存在肿瘤与血管之间的蛛网膜界面,提倡在第1次手术中采用积极的显微外科治疗.     

中央沟区矢状窦旁脑膜瘤显微手术的临床分析

目的：探讨中央沟区矢状窦旁脑膜瘤显微手术的临床分析。方法从2009年6月～2012年6月收治的22例中央沟区矢状窦旁脑膜瘤患者,进行分析,采用显微外科手术治疗,观察分析患者的疗效。结果按Simpson 手术分级评定手术结果,SimpsonⅠ级切除8例,Simpson Ⅱ级切除4例,Simpson Ⅲ级切除10例,无手术死亡病例。术后随访6个月～2年,复发1例。结论中央沟区矢状窦旁脑膜瘤采用显微手术治疗,能有效控制术中出血,保护上矢状窦及中央沟静脉,提高肿瘤全切率。     

显微手术和非显微手术治疗椎管内肿瘤100例的比较分析

目的比较非显微手术与显微手术治疗椎管内肿瘤的临床疗效及术后恢复情况。方法回顾性分析100例椎管内肿瘤患者的临床资料,对非显微手术组与显微手术组的治疗效果进行了比较分析。结果 A组(显微手术组)手术时间(3.9±0.8)h,出血量(414±87)ml,脑脊液漏发生2例(发生率4.0%),平均住院时间(13±3)d;B组(非显微手术组)手术时间(2.1±0.5)h,出血量(680±106)ml,脑脊液漏发生9例(发生率18.0%),平均住院时间(22±13)d。A组有47例患者肿瘤全切除(全切率94%),B组全切除肿瘤仅34例(全切率68%)。A组中疼痛患者有93.3%有所缓解;感觉障碍的患者有76.5%得到不同程度的缓解,2例加重;运动障碍的患者都得到不同程度的改善;尿潴留或尿失禁患者有86.7%得以缓解。B组中疼痛患者仅有63.6%症状有所缓解;感觉障碍的患者有54.2%得到不同程度的缓解;运动障碍的患者有55%得到不同程度的改善;尿潴留或尿失禁患者仅45.5%得以缓解。可见显微手术组各方面均优于非显微手术组(P<0.05)。术后随访时间为6个月~3年,平均随访时间28.3个月,随访率76%。A组随访患者术后未见并发症发生;B组随访患者术后肿瘤复发6例,继发性椎管狭窄5例。结论显微手术治疗椎管内肿瘤具有创伤小、安全性高等优点。显微手术是治疗椎管内肿瘤的有效方法。     

Cranial nerve assessment in cavernous sinus tumors with contrast-enhanced 3D fast-imaging employing steady-state acquisition MR imaging

Introduction  The purpose of this study is to apply contrast-enhanced 3D fast-imaging employing steady-state acquisition (3D-FIESTA) imaging to the evaluation of cranial nerves (CN) in patients with cavernous sinus tumors. Methods  Contrast-enhanced 3D-FIESTA images were acquired from ten patients with cavernous sinus tumors with a 3-T unit. Results  In all cases, the trigeminal nerve with tumor involvement was easily identified in the cavernous portions. Although oculomotor and abducens nerves were clearly visualized against the tumor area with intense contrast enhancement, they were hardly identifiable within the area lacking contrast enhancement. The trochlear nerve was visualized in part, but not delineated as a linear structure outside of the lesion. Conclusions  Contrast-enhanced 3D-FIESTA can be useful in the assessment of cranial nerves in and around the cavernous sinus with tumor involvement.     

鼻咽癌侵犯前中颅窝的MRI表现

目的探讨鼻咽癌向前、中颅窝侵犯的ＭＲＩ征象。方法回顾分析３９例有颅神经损伤并经病理确诊的鼻咽癌病例,用１．０Ｔ磁共振机,行头颅、鼻咽部轴位和冠状面Ｔ１ＷＩ、Ｔ２ＷＩ和矢状面Ｔ２ＷＩ扫描,应用钆喷替酸葡甲胺（ＧｄＤＴＰＡ）增强后,分别行轴位、冠状面、矢状面Ｔ１ＷＩ扫描。结果（１）前颅窝受侵１３例,筛窦受侵３例,眶尖、球后受侵４例,两者同时受侵６例。（２）中颅窝受侵３８例,蝶骨体破坏３２例,蝶窦肿块２５例,破裂孔异常２０例,卵圆孔异常２８例,蝶鞍破坏６例,海绵窦受侵３５例。结论鼻咽癌经破坏颅底骨质、进出颅腔的自然骨性通道和两者并存的３种途径向前、中颅窝侵犯,ＭＲＩ能准确显示侵犯途径和程度     

Roentgenological investigation of cavernous sinus structure with special reference to paracavernous cranial nerves

Summary We have evaluated the anatomical structure of cavernous sinuses in parasellar blocks obtained from adult cadavers to gain clinically useful information. Ten microdissectional studies of parasellar blocks (20 sides of cavernous sinus) were carried out with special emphasis on the course of paracavernous cranial nerves (3rd to 6th). These were also examined on plain radiographs. Secondly, CT investigations of the cavernous sinuses (notably as to paracavernous cranial nerves) were undertaken in twenty clinical cases having presumed parasellar lesions and in three parasellar blocks from cadavers. The results from microdissectional studies and plain radiographs were as follows. It was found that the 3rd cranial nerve entered the lateral wall of the cavernous sinus close to the antero-inferior part of the posterior clinoid on lateral projection. The 4th cranial nerve, on the other hand, entered near the postero-inferior portion of the posterior clinoid on the same view. Variations in Parkinson's triangle were fairly often noted, although marked asymmetry was not seen in individual cases. From CT findings, it was found that a postenhanced, magnified direct coronal study was essential for identifying paracavernous cranial nerves more clearly. The 3rd and 5th cranial nerves were fairly well identified on axial and coronal projections. Careful radiological investigation including plain skull radiographs & CT seems to be of value for those who diagnose or treat parasellar lesions.     

Perineural tumor extension to the cavernous sinus from superficial facial carcinoma: CT manifestations

The mechanism of cavernous sinus involvement by metastatic carcinoma from a facial primary tumor is poorly understood. The lack of lymphatic and obvious direct extension implicate either a vascular or perineural method of spread. The authors describe four patients who exhibited cavernous sinus metastases from facial carcinoma, all of whom experienced cranial nerve symptoms before the diagnosis of cavernous sinus involvement was made. Furthermore, the pathologic specimens from these patients exhibited extensive perineural involvement. The authors propose that the mechanism of metastasis in these patients is perineural extension.     

以眼科症状首诊的鼻咽癌MRI特征

目的 探讨以眼科症状首诊的鼻咽癌患者的MRI表现.方法 回顾性分析经病理证实的22例鼻咽癌患者Ⅲ、Ⅳ和(或)Ⅵ组颅神经侵犯的临床及MRI表现.结果 22例鼻咽癌患者病变均沿眼运动神经走行分布区浸润扩散.22例患者中复视者14例.发生外展神经、动眼神经和滑车神经不全麻痹者分别为12例(16侧)、6例(7侧)和3例(4侧).MRI表现:海绵窦受累表现为增厚型(8例共10侧)或肿块型(14例共16侧);眶上裂扩大4例4侧,眶上裂软组织信号影9例共10侧;眼外肌受累8例共10侧,表现为眼外肌增粗、周围脂肪间隙模糊伴异常强化;10例动态增强扫描显示鼻咽部病变与海绵窦、眶内病变的动态增强扫描曲线一致,均表现为速升平台型.结论 眼运动神经损害是鼻咽癌的首诊症状之一,应用MR检查可以明确诊断.     

经面静脉-眼上静脉入路治疗颈动脉海绵窦瘘

目的　评价经面静脉 眼上静脉入路治疗颈动脉海绵窦瘘 (CCF)的有效性。方法 :经股静脉 面静脉 眼上静脉入路到达患侧海绵窦 ,用GDC或EDC ,游离弹簧圈 ,真丝线段等多种栓塞材料填塞海绵窦 ,同时闭塞瘘口。面静脉插管困难者 ,在下颌角附近切开皮肤显露面静脉 ,直视下穿刺面静脉放置相应导管 ,再经眼上静脉到达患侧海绵窦并将其填塞。结果 :经面静脉 眼上静脉入路对 14例、16侧海绵窦进行了栓塞治疗 ,其中 5例为外伤性、直接CCF(A型 ) ,经动脉途径球囊栓塞后复发 ,或微弹簧圈栓塞未能成功 ,或经岩下窦入路未能成功 ,9例为自发性、间接CCF(D型 8例 ,C型 1例 )。 13例经股静脉 面静脉 眼上静脉途径 ,1例通过直视下面静脉穿刺。 11例栓塞治疗后即刻造影显示瘘消失 ,2例残留低流量的岩下窦引流 ,另有 1例在微导管进入面静脉后 ,面静脉痉挛闭塞 ,未能继续进行栓塞治疗 ,造影仍见瘘存在 ,但眼静脉出现明显的造影剂滞留。 1例A型CCF在球囊栓塞后出现外展神经麻痹 ,经面静脉 眼上静脉栓塞后亦无改善。因面静脉痉挛闭塞未能栓塞成功者 ,于术后即感眼部症状加重 ,但第 2天感症状缓解 ,术后第 2 1天症状明显改善 ,造影检查发现瘘口已经消失 ,术后 1个月患者眼部症状完全消失。其他病例在栓塞术后眼部症状明显改善 ,     

Coil embolization of cavernous sinus in patients with direct and dural arteriovenous fistula

To determine technical success and acute complication rates after endovascular coil packing of the cavernous sinus. Nineteen patients presented with either direct (13) or dural (6) arteriovenous fistula (AVF) and were treated by means of coil embolization of the cavernous sinus. The aim of treatment was complete obliteration of the fistula. In a retrospective study, the degree of obliteration, regression of symptoms as well as complication rates were evaluated. Initial complete obliteration was achieved in 12 patients, subtotal occlusion of the sinus in 6 and incomplete packing with major residual fistula in 1 of the patients. Retreatment was successfully performed in two patients with early recurrence of AVF. Follow-up showed complete occlusion rates in 16 and subtotal obliteration in 3 patients. Chemosis and exophthalmus regressed rapidly in all affected patients. Persistence of cranial nerve deficits was observed in 11 cases. Postinterventional thrombosis of the ophthalmic vein was the only major acute complication (n = 2). Coil embolization of the cavernous sinus in cases with AVF is a complex procedure that is technically feasible and safe in the majority of cases. Adequate anticoagulation is recommended to avoid thrombembolic complications. Long-term outcome has to be determined by further studies.     

Cavernous sinus invasion by pituitary adenomas

One hundred ninety-eight surgically explored pituitary adenomas were evaluated preoperatively by high-resolution computed tomography (CT). At surgery, evidence of direct cavernous sinus invasion was demonstrated in 19. CT findings in these cases included cavernous sinus expansion (17 patients) and visible encasement of the internal carotid artery (14 patients). The invasive tumor often enhanced to a lesser degree than the cavernous sinuses and ipsilateral internal carotid artery. Intracavernous cranial nerve compression, obliteration, or displacement (14 patients), invasion of the lateral wall of the cavernous sinus (seven patients), and diffuse bone destruction (seven cases) were other findings. Magnetic resonance imaging in three patients provided excellent demonstration of intracavernous internal carotid artery encasement, but displacement and obliteration of intracavernous cranial nerves was not shown as well as it was with CT. Histologically, only three patients showed anaplastic features and only one of them had distant metastases. There was no correlation between histologic features, hormone assays, and invasiveness. This experience indicates any type of pituitary adenoma, regardless of its endocrinologic activity, can invade the cavernous sinus. Cavernous sinus involvement makes complete surgical removal difficult. Preoperative recognition of invasive behavior of these tumors has prognostic value and aids in designing appropriate management. CT is the most useful technique generally available for evaluation and follow-up.     

鞍旁病变的MR诊断

目的　通过总结 5 9例鞍旁病变的MR表现 ,探讨鞍旁病变的MR诊断和鉴别诊断。方法　 5 9例鞍旁病变 ,均行MR平扫检查 ,41例行MR增强扫描。 3 5例经手术病理证实 ,2 4例经临床证实。结果　鞍旁脑膜瘤信号和强化表现与其他部位脑膜瘤类似 ,累及垂体时需要与垂体瘤侵犯海绵窦鉴别。肿瘤从桥小脑角延伸到鞍旁是三叉神经瘤的特点。转移瘤常见于鼻咽癌颅内侵犯。痛性眼肌麻痹表现为海绵窦增大和动眼神经强化。海绵状血管瘤可以呈长T1 长T2 信号 ,显著强化。动脉瘤呈流空低信号 ,可以有血栓形成。结论　多数鞍旁病变MR表现有特点 ,少数需要结合临床进行鉴别诊断     

脊髓海绵状血管瘤的诊断与显微外科治疗

目的　总结脊髓海绵状血管瘤显微外科治疗的经验。方法　对 1992年 3月～ 2 0 0 2年 12月收治的 17例脊髓海绵状血管瘤病例进行了回顾性分析。手术均采用后正中入路 ,显微直视下切除病变。结果　 17例脊髓海绵状血管瘤病例中 ,全切 13例 ,部分切除4例。术后 11例脊髓功能改善 ,4例无变化 ,2例加重 ,无死亡。结论　脊髓MRI检查是确诊本病的惟一可靠手段 ,娴熟的显微神经外科技术可使该类手术治疗取得良好效果。