桥小脑角区脑膜瘤的分型及显微外科治疗

目的 探讨桥小脑角区脑膜瘤的分型及显微外科治疗。方法 回顾性分析2008年6月至2017年3月收治的76例桥小脑角区脑膜瘤的临床资料，根据术前检查及术中判断分为内听孔前型31例，内听孔后型17例，大型联合型28例。73例采用枕下乙状窦后入路，2例使用颞下入路，1例使用翼点入路。结果 肿瘤全切除71例，次全切除5例。术后随访1~10年，术后新增神经症状15例，其余病人术后症状均改善；复查头颅MRI，复发3例；死亡2例。结论 显微手术切除桥小脑角区脑膜瘤可获得满意效果及良好预后；扩大枕下乙状窦后入路可满足绝大多数桥小脑角区脑膜瘤切除的需要；颅神经、岩静脉及重要动脉的保护和处理在桥小脑角区脑膜瘤显微外科治疗中具有重要意义。     

神经内镜辅助显微手术治疗桥小脑角肿瘤

目的 探索经乙状窦后入路电视神经内镜辅助显做手术治疗桥小脑角肿瘤的实用性及其优势。方法 对33例桥小脑角肿瘤采取乙状窦后入路神经内镜辅助显微手术治疗。结果 10例听神经瘤全切并保留面神经，22例胆脂瘤及1例脑膜瘤全切除，无术后并发症及死亡。结论 经乙状窦后入路神经内镜辅助显微手术治疗桥小脑角肿瘤，可提高手术疗效，降低手术危险性。     

以三叉神经痛和/或面肌痉挛起病的桥小脑角区肿瘤的手术治疗

目的探讨经枕下乙状窦后入路手术治疗以三叉神经痛和/或面肌痉挛起病的桥小脑角区肿瘤的临床疗效。方法回顾性分析2014年9月至2016年9月收治的21例以三叉神经痛和/或面肌痉挛起病的桥小脑角区肿瘤的临床资料,均采用枕下乙状窦后入路手术切除肿瘤,其中17例同期行微血管减压术。结果肿瘤全切除18例,近全切除3例。术后原有面部疼痛或不自主抽搐症状消失或明显减轻。术后随访3~27个月,临床症状和肿瘤均无复发。结论枕下乙状窦后入路手术治疗以三叉神经痛和/或面肌痉挛起病的桥小脑角区肿瘤的疗效确切,安全性高,并发症少,对于同时存在血管压迫的病例,可同期行微血管减压术治疗。     

儿童第四脑室-小脑脚-脑干区肿瘤的手术治疗

目的 研究第四脑室-小脑脚-脑干区肿瘤的形态学特点，以及安全地切除此部位肿瘤的手术方法。方法 儿童（15岁以下）第四脑室-小脑脚-脑干区肿瘤（室管膜瘤和星形细胞瘤）23例。术前头颅MRI证实瘤体起源于小脑脚或侧隐窝，分别向第四脑室，脑干，CPA和斜坡生长。采用枕下正中外侧拐入路，术中分区域切除肿瘤，结果 全切除肿瘤12例，近全切除9例，大部切除2例，无手术死亡，术后病理证实室管膜瘤13例，恶性室管膜瘤2例，星形细胞瘤8例。结论 起源于小脑脚或侧隐窝的肿瘤，以脑干为中心呈半弧形生长，肿瘤侵袭范围包括第四脑室，小脑脚，脑干，CPA和斜坡，合适的手术入路和术中分区域切除肿瘤的技术，可以做到安全地全切除和/或近全切除肿瘤。     

经乙状窦前岩骨入路切除桥脑小脑角及岩斜坡肿瘤

14例桥脑小脑角及岩斜坡区肿瘤经乙状窦前岩骨入路手术切除。肿瘤全切除8例、次全切除5例、部分切除1例。无手术死亡。作者认为肿瘤直径3cm以上且不同程度向脑干腹侧生长,跨越岩骨尖达中颅窝时采用该入路,与传统乙状窦后枕下入路相比具有优越性。     

内镜下经颅脑桥小脑角区肿瘤切除术手术要点分析

目的 总结内镜下经颅脑桥小脑角区肿瘤切除术的手术要点.方法 纳入2019年1月至2020年12月中南大学湘雅医院诊断与治疗的28例脑桥小脑角区肿瘤患者,均行内镜下经颅入路手术切除脑桥小脑角区肿瘤.结果 28例患者均顺利完成内镜下经颅脑桥小脑角区肿瘤切除术,并全切除肿瘤.术后经病理证实听神经瘤9例,脑膜瘤8例,胆脂瘤9例...     

经岩骨四种联合入路临床运用的初步经验

报告经岩骨四种联合入路手术治疗颅内大型肿瘤３０例。经迷路经小脑幕入路切除听神经瘤１８例，经乳突经小脑幕入路切除其它桥小脑角肿瘤７例，后者与颞下入路联合切除中、后颅窝亚铃型肿瘤２例，与乙状窦后入路联合切除桥小脑角脑膜瘤３例。肿瘤全切除率为９０％，术后重残或死亡３例。本文着重对手术方法，手术适应证和手术后并发症的防治进行简要讨论。     

神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤

目的:探讨神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤的治疗效果及应用价值。方法:应用神经内窥镜辅助显微外科手术治疗桥脑小脑角区胆脂瘤20例,均采用乙状窦后入路。结果:显微镜下手术后应用0°、30°内窥镜观察,20例均有不同程度的肿瘤残留。神经内窥镜辅助下继续行残余肿瘤切除,全切18例,次全切2例。术后无死亡及无菌性脑膜炎表现。术后3个月,随访16例患者,均恢复正常生活。结论:经乙状窦后入路的神经内窥镜辅助显微手术治疗桥脑小脑角区胆脂瘤,可提高肿瘤切除率,减少对脑干及颅神经的牵拉和对重要血管的损伤,降低手术危险性及术后并发症,提高手术疗效,缩短住院时间。     

枕下乙状窦后入路显微外科治疗听神经瘤

目的观察枕下乙状窦后入路显微外科治疗听神经瘤的治疗效果。方法 35例听神经瘤患者均采用枕下乙状窦后入路行显微手术切除。结果本组患者肿瘤全切23例(62.9%),次全切除9例(25.7%),部分切除3例(8.6%);面听神经解剖结构保留29例(82.9%)。结论显微手术切除听神经瘤有较好的临床疗效,熟练掌握桥小脑角区的局部解剖、手术入路及显微操作技巧可提高全切率和面听神经保留率。     

原发性桥小脑角淋巴瘤1例

目的报告1例原发性桥小脑角淋巴瘤并文献回顾。方法回顾性分析1例经枕下乙状窦后入路手术的桥小脑角淋巴瘤病人的临床资料,分析桥小脑角淋巴瘤的临床特征、影像学特点、鉴别诊断及治疗。结果第1次手术全切除肿瘤,病理诊断为B细胞型淋巴瘤,术后1个月肿瘤复发,再次手术全切除肿瘤,术后辅以化疗,随访2个月未见肿瘤复发。结论原发于桥小脑角的淋巴瘤少见,术后易复发,需辅以放化疗等综合治疗。     

桥小脑角肿瘤术中面、听神经监护

目的研究术中监护下桥小脑角肿瘤显微镜下切除的临床疗效。方法在41例桥小脑角肿瘤切除手术中,均进行脑干听觉诱发电位和面神经肌电图监护。结果肿瘤全切除者33例,次全切除者7例,大部切除者1例。41例患者均达到了面神经解剖保留,27例(65.9%,27/41)患者保留听力,其中14例为听神经瘤,占听神经瘤的56.0%(14/25)。结论术中脑干听觉诱发电位和面神经肌电图监护对于桥小脑角肿瘤切除术有重要的临床价值。     

Malignant Transformation of an Epidermoid Cyst in the Cerebellopontine Angle

Intracranial squamous cell carcinoma is extremely rare, with most of the cases arising from malignant transformation of an epidermoid or a dermoid cyst. The patient presented with facial weakness. Initial magnetic resonance imaging revealed a mass in the right cerebellopontine angle. A subtotal resection was performed via right retrosigmoid suboccipital approach. Histopathological findings were consistent with an epidermoid tumor. Five months later, the patient underwent gamma knife radiosurgery due to highly probable recurrent epidermoid tumor. Two years after, the patient''s neurological deficit had been newly developed, and follow-up magnetic resonance imaging demonstrated a large contrast-enhancing tumor in the left cerebellopontine angle, which compressed the brainstem. After resection of the tumor, histopathological examinations revealed a squamous cell carcinoma probably arising from an underlying epidermoid cyst. We report a case of an epidermoid tumor in the cerebellopontine angle that transformed into a squamous cell carcinoma.     

颞枕经小脑幕入路显微手术切除岩斜区脑膜瘤

目的 探讨颞枕经小脑幕人路切除岩斜区脑膜瘤的可行性.方法 对18例经颞枕入路切除的岩斜区脑膜瘤患者进行回顾性研究.全部病例均在术前行MRI检查.结果 18例于术患者,肿瘤直径<3.0cm4例;3.0-4.5cm5例;>4.5 cm 9例,最大径可达到7.6 cm×7 cm X7 cm.全切8例,次全切9例,大部分切除1例.偏瘫2例,面瘫1例.听力减退1例,无脑脊液耳漏、失语.1例死亡.结论 颞枕经小腩幕入路切除岩斜区脑膜瘤具有可行性,可以使鞍旁海绵窦区、上中斜坡、岩骨背侧小脑脑桥角区暴露充分,利十该区域占位性病变的手术治疗.     

脊髓髓内室管膜瘤的外科治疗策略与疗效分析

目的探讨脊髓髓内室管膜瘤的治疗策略。方法对210例髓内室管膜瘤病人的神经功能状况、肿瘤切除程度、术后并发症与疗效等进行回顾性分析。均行肿瘤显微切除术,椎板复位135例。结果肿瘤全切除195例,次全及大部切除15例。术后行气管切开8例,均为延髓及高颈髓部位的巨大肿瘤病人。术后门诊复查及电话随访130例,随访时间3个月~9年;神经功能改善95例(73%),明显加重21例(16%),无变化14例(11%);术后复发5例,其中肿瘤位于圆锥部分3例,胸髓1例,延颈髓1例。结论大多数髓内室管膜瘤通过早期诊断与及时手术,可获得肿瘤全切除,预后良好。对于严重黏连的肿瘤不应勉强追求全切除。术前功能分级差者,术后神经功能障碍易加重。     

显微手术治疗室管膜瘤30例分析

目的 总结室管膜瘤的显微手术治疗经验.方法 显微手术治疗室管膜瘤30例并随访.结果 肿瘤全切21例,大部分切除8例,1例多发者切除四脑室肿瘤,桥小脑角肿瘤行γ刀治疗.结论 采用显微外科技术,尽可能全切除肿瘤是治疗室管膜瘤的最有效手段及治疗原则,不主张放射治疗.     

Facial neuroma masquerading as acoustic neuroma

Facial nerve neuromas are rare benign tumors that may be initially misdiagnosed as acoustic neuromas when situated near the auditory apparatus. We describe a patient with a large cystic tumor with associated trigeminal, facial, audiovestibular, and brainstem dysfunction, which was suspicious for acoustic neuroma on preoperative neuroimaging. Intraoperative investigation revealed a facial nerve neuroma located in the cerebellopontine angle and internal acoustic canal. Gross total resection of the tumor via retrosigmoid craniotomy was curative. Transection of the facial nerve necessitated facial reanimation 4 months later via hypoglossal-facial cross-anastomosis. Clinicians should recognize the natural history, diagnostic approach, and management of this unusual and mimetic lesion.     

Holocord ependymoma

Intramedullary tumors affecting the entire cord from the cervicomedullary junction to the conus are termed "holocord tumors". Ependymomas are the most frequent intramedullary tumor in adults. Holocord ependymoma is an exceedingly rare condition. An extensive review of the literature revealed that only five other cases have been reported. We report the sixth case of holocord ependymoma. In this article, we present a case of holocord ependymoma in a 19-year-old girl which was totally resected in a two-stage approach. A two-staged operation is recommended for the aim of total resection for this disease. Besides, cysts are common feature of all spinal ependymomas. There was a solid mass not accompanied by a cyst a any level in our patient's tumor. To the authors' best knowledge, a pure solid mass not accompanied by a cyst has not been previously reported with holocord ependymoma cases.     

Therapeutic results of eight patients with intracranial ependymomas]

Between 1985 and 2001, eight patients with intracranial ependymomas underwent surgery at our hospital. The cases included six infratentorial ependymomas, one supratentorial ependymoma and one supratentorial anaplastic ependymoma. Infratentorial ependymomas were classified according to origin and extension. The lateral type tumors originated from the lateral part of the fourth ventricle in four cases. The midfloor type tumors originated from the inferior half of the fourth ventricular floor in two cases. The three totally resected tumors were the lateral type tumors. The remaining one case with the lateral type tumor underwent nearly total resection of the tumor, since the tumor involved lower cranial nerves. All patients with the midfloor type tumors underwent incomplete resections of the tumors, because the tumors infiltrated into brain stem. Lower cranial nerve involvement and brain stem invasion implied incomplete resection and had the poor prognosis. In intracranial ependymomas, all four patients with total resections have been alive, whereas three of four patients with incomplete resections have died. The mean survival time of all patients with intracranial ependymomas was 127 months from the time of the initial surgery. There were no deaths in the patients with tumors showing MIB-1 index < 10% (n = 4). The mean survival time of the patients with tumors showing MIB-1 index > or = 10% (n = 4), was 30 months. The extent of the resection, the age of the patients and MIB-1 index are important factors in the outcome in patients with intracranial ependymomas. Two representative children aged less than 3 years with the midfloor type tumors were presented. In a patient treated with conventional radiation and chemotherapy, residual tumor repeatedly enlarged within 12 months despite several resections of the tumor. The patient died 32 months after the initial resection. In contrast, the other patient received multidisciplinary treatment including Linac stereotactic radiotherapy (SRT) with a marginal dose of 27 Gy in 9 fractions, have been still alive for 45 months after the initial resection. The residual tumor slightly decreased in size and remained stable without evident growth 12 months after SRT. SRT may provide good local control for patients with intracranial ependymomas and have a favorable impact on survival.