颞盂入路及其在颈静脉球体瘤切除术中的应用

目的介绍颞盂入路切除向颅内外扩展的颈静脉球体瘤。方法采用颞盂入路联合乳突或乳突枕下入路,监控颈内动脉(ICA)和面神经远心端,从颈静脉孔外、后、下3个侧面,于直视下分离切除肿瘤。结果5例颈静脉球体瘤成功切除,术后恢复良好(无下颌运动障碍)。结论颞盂入路联合乳突或乳突枕下入路,可监控ICA远心端和面神经,充分暴露并安全切除颈静脉球体瘤。     

颈静脉球体瘤误诊分析

目的提高颈静脉球体瘤的诊断水平,研究其误诊因素,降低误诊率。方法回顾性分析47例颈静脉球体瘤患者的临床、术前影像学及病理学诊断资料。结果47例中34例首诊时误诊（72.3％）,误诊疾病分别为慢性中耳炎、分泌性中耳炎、外耳道肿物、神经性耳鸣、Bell麻痹、慢性咽喉炎、神经性耳聋、眩晕、突聋、声带麻痹。术前,影像误诊8例（17.0%）,分别为慢性中耳炎及血管瘤;病理检查10例,误诊8例（80.0%）,分别为外耳道炎性肉芽组织、血管瘤、炎性息肉、鳞状上皮及角化物。结论颈静脉球体瘤少见,临床症状无特征性表现,CT及MRI为重要的诊断依据,免疫组织化学检查有助于颈静脉球体瘤的诊断及鉴别诊断,医师对该病认识不足是导致误诊的主要原因。     

Assessment of dysequilibrium after acoustic neuroma removal.

OBJECTIVE: Published data evaluating the rate of dysequilibrium after acoustic neuroma removal are inconsistent. The purpose of this investigation was to determine the incidence and severity of dysequilibrium and quality of life in a group of patients after acoustic neuroma surgery. STUDY DESIGN: The study design was a retrospective chart review and survey that included demographic and medical history questions, the Dizziness Handicap Inventory (DHI), the UCLA Dizziness Questionnaire (UCLA-DQ), and the Health Status Questionnaire (HSQ). SETTING: The study was conducted in a multispecialty tertiary care clinic. PATIENTS: Two hundred thirty-seven subjects who underwent initial surgical removal of an acoustic neuroma between January 1990 and June 1997 were studied. MAIN OUTCOME MEASURES: Correlation of dysequilibrium with age, gender, and tumor size was measured. Survey analysis including DHI, UCLA-DQ, and HSQ scores. Results: Sixty-five percent of patients reported persistent dysequilibrium after surgery. A majority of those with dysequilibrium had DHI, UCLA-DQ, and HSQ scores that suggested minimal impact on the quality of life. The HSQ scores were statistically significantly poorer for the patients with dysequilibrium than for those without dysequilibrium. CONCLUSIONS: Sixty-five percent of patients reported dysequilibrium after acoustic neuroma removal. The quality-of-life impact was mild.     

Ultrastructure of the glomus jugulare tumor

Summary An electron microscopic study was done on a glomus jugulare tumor from a 69-year-old male. With the electron microscope, it was found that most of the tumor cells and their processes seemed to be in close contact with capillaries, whose endothelial cells were fenestrated by pores. The most significant structure in the glomus tumor cell is a large number of membrane-bounded electron dense granules, morphologically similar to the catecholamine-containing granules. The functional significance of the occurrence of such granules is discussed.

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Zusammenfassung Die Morphologie eines glomus jugulare Tumors, bei ennem 69 jährigen Patienten, wird an Hand einer elektronenmikroskopischen Untersuchung beschrieben, Die meisten Tumorzellen oder ihre Fortsätze scheinen in engem Kontakt mit Capillargefäßen zu stehen. Das Endothel dieser Gefäße weist Poren auf. Die Tumorzellen enthalten zahlreiche osmiophile Körnchen, die morphologisch den Catecholamin-haltigen Körnchen ähneln. Ihre funktionelle Bedeutung wird diskutiert.

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This investigation was supported by Grants # NB 07623, NB 05349 and NB 04615 from the Institute of Neurologic Diseases and Stroke, The National Institutes of Health.     

Conductive hearing loss after removal of acoustic neuroma.

OBJECTIVE: To report 4 patients who have developed a conductive and/or mixed hearing loss due to dehiscence of the inner ear after retrosigmoid approach for removal of acoustic neuroma. PATIENTS: Four patients who presented with conductive and/or mixed hearing loss after retrosigmoid approach for removal of acoustic neuroma. MAIN OUTCOME MEASURE: Evidence of inner ear dehiscence on postoperative computed tomographic scan of the temporal bones. CONCLUSION: The occurrence of conductive hearing loss after the surgical removal of an acoustic neuroma has not previously been documented. Computed tomographic scan of the temporal bones showing inner ear dehiscence may explain this finding. Formal documentation of such cases may allow techniques to be developed to reduce its occurrence or reconstruction of the defect at the time of primary surgery.     

Postoperative Ramsay-Hunt syndrome after acoustic neuroma resection. Viral reactivation

The aim of this paper is to present a patient suffering from acoustic neuroma and operated on with immediate postoperative hearing and facial function preservation who developed delayed Ramsay-Hunt syndrome. To our knowledge, this is the first case in whom a postoperative delayed facial palsy and hearing loss occurred. The patient gave an history of previously diagnosed herpes zoster reactivation limited to chest one-year before. This is undoubtdetly a predisposing factor for development of delayed facial palsy. It must not be underestimated and it obliges to consider a prophylaxis. Theoretically, the prophylactic antiviral therapy might prevent the evolution towards the herpes zoster oticus or reduce the severity of the symptoms allowing the preservation of the hearing function. It would be pointed out that the delayed facial plasy has favourable prognosis, while the hearing impairment may recover with a greater difficulty even after an antiviral treatment as in our case.     

Facial nerve recovery after acoustic neuroma removal

A retrospective analysis of 76 patients who underwent acoustic neuroma removal is reported. Facial nerve function prior to surgery and tumour size are assessed with respect to final facial nerve recovery and the need for surgical rehabilitation. Both pre-operative facial weakness and tumour size greater than 2.5 cm. are shown to be predictive factors of poor facial nerve recovery. Multiple surgical rehabilitative procedures are often required when inadequate function and/or cosmetic results are obtained. Primary nerve repair and facial-hypoglossal anastomosis give better rehabilitative results than dynamic and static procedures. The association of tumour size greater than 2.5 cm. with increased risk of poor facial recovery re-emphasizes the need to detect and remove acoustic neuromas at an early stage.     

Spatial hearing disability after acoustic neuroma removal

OBJECTIVES/HYPOTHESIS: Previous studies on hearing loss (HL) after acoustic neuroma removal concentrate mainly on pure-tone hearing results rather than hearing disability. Our objectives were to use the Speech, Spatial and Qualities of Hearing scale (SSQ), a comprehensively validated questionnaire, to characterize and quantify the auditory disabilities that patients experience with a profound unilateral HL after acoustic neuroma removal. STUDY DESIGN: Forty-four patients with profound unilateral HL after acoustic neuroma surgery completed the SSQ. Their findings were compared with those of a control population sample matched for age, sex, and hearing level in the better hearing ear. RESULTS: In comparison with controls, with use of analysis of variance, acoustic neuroma patients scored poorly on all items except for the identification of sounds and objects (P = .123). The greatest difficulties involved speech in the presence of noise, situations of multiple speech-streams and switching (such as listening to someone speaking and the television at the same time), the location of unseen objects, and increased listening effort (P < .05). CONCLUSION: This study demonstrates that, compared with a control population, these patients experience a significant range of auditory disabilities. It is important that clinicians be aware of the impact of such a profound unilateral HL and its potential to affect daily life. Patient counseling prior to surgery is essential, especially in patients whose loss of binaural hearing could constitute a major disability.     

Facial palsy after glomus jugulare tumour embolization.

Facial palsy after pre-operative embolization of glomus tumours is a rare complication. In our case, complete facial palsy occurred within four hours after embolization with polyvinyl alcohol foam. Three days later, embolization material was found in the perineural vessels of the facial nerve in its mastoidal segment. Six months after complete tumour removal, facial decompression with perineural incision, and steroid therapy, facial function recovered completely. In cases of embolization of both stylomastoid and branches of the middle meningeal artery with resorbable material, temporary facial palsy can occur.     

颈静脉球体瘤的诊断与治疗

目的 提高对颈静脉球体瘤的认识,以利于其诊断和治疗.方法 回顾性分析颈静脉球体瘤12例,总结其临床表现、影像学特征、治疗方法 及效果.结果 颈静脉球体瘤早期常见的临床症状为搏动性耳鸣和听力下降,中晚期常出现耳部症状及面神经麻痹等神经症状;MRI检查可见特征性表现:"椒一盐"征;根据肿瘤大小及部位、扩展方向采用不同的手术入路取得了较好疗效.结论 颈静脉球体瘤临床表现复杂,容易误诊,CT、MRI的应用提高了对颈静脉球体瘤的诊断水平,手术的方式决定于肿瘤的大小、侵犯范围、有无联合病变以及颅神经状况,应根据个体情况而定.     

A metastatic glomus jugulare tumor. A temporal bone report

The clinicopathologic findings in the temporal bone of a patient with a highly malignant metastasizing glomus jugulare tumor are reported. The patient exhibited all the symptoms of primary malignant tumors of the ear, including facial paralysis, otorrhea, pain, hearing loss, tinnitus, dizziness, and vertigo. He was treated with cobalt irradiation followed by radium implant in the ear canal for a residual tumor; then a left-sided radical mastoidectomy was performed.     

颈静脉球体瘤及颈动脉体瘤的诊断和治疗

目的：探讨颈静脉球体瘤及颈动脉体瘤的诊断方法和治疗经验。方法：回顾一家系4例颈静脉球体瘤及颈动脉体瘤患者的临床资料,分析其临床特点、影像学特征、手术方法和预后情况。先证者为左侧颈静脉球体瘤伴左侧颈动脉体瘤,先证者亲妹妹为右侧颈动脉体瘤,先证者堂妹为双侧颈动脉体瘤伴右侧颈静脉球体瘤,先证者堂哥为双侧颈动脉体瘤伴左侧颈静脉球体瘤。4例患者均接受全身麻醉下手术治疗。患者术前均行颈部超声、CT或CT血管造影（CTA）、MRI及数字减影血管造影（DSA）检查,3例术前行血管栓塞。结果：4例患者手术顺利,均无肢体偏瘫或死亡病例。随访24~29个月,无复发。术后半年堂哥声嘶消失,堂妹声嘶无明显好转。术后1年堂妹出现右侧周围性面瘫,颞骨CT示右侧颈静脉球体瘤。结论：颈部超声、CT、CTA、MRI及DSA是颈静脉球体瘤、颈动脉体瘤的主要影像学诊断方法,对指导治疗及制定手术方案具有重要价值。手术切除是首选的治疗方法,术前进行血管栓塞可减少术中出血,术中使用显微镜可提高术野清晰度,避免大血管及神经损伤,避免严重并发症发生。     

Combined approach surgery for removal of glomus jugulare tumors

The ideal surgical treatment for glomus jugulare tumors is total removal. Efforts have been made periodically to accomplish this since shortly after this tumor was first identified in the early 1940's. This paper describes a method of removal using a combined approach through the neck and temporal bone, preceded by a course of preoperative irradiation therapy. The early results that have been obtained using this procedure in 10 patients are reported.     

Benign intracranial hypertension complicating glomus jugulare tumor surgery

A case is reported in which excision of the jugular bulb during glomus tumor surgery resulted in the development of postoperative benign intracranial hypertension. The pathogenesis of this previously unreported complication of glomus tumor surgery is discussed, and the principles of management are reviewed.