颈静脉孔区神经鞘瘤17例临床分析

目的 探讨颈静脉孔区神经鞘瘤的临床分型和手术疗效。方法 对17例颈静脉孔区神经鞘瘤患者的临床表现、手术方式和预后进行回顾性分析。17例患者中,男性8例,女性9例,就诊前平均病程53．2个月;主要临床表现有Ⅶ、Ⅷ颅神经损伤,舌肌萎缩和后组颅神经损害;按Samii分类法,A型5例、B型3例、C型2例、D型7例。结果 手术采用远外侧入路10例,枕下入路5例,经下颌骨、经颌下入路2例;全切除肿瘤12例,次全切除5例;术后症状改善9例,症状同术前3例,术后出现神经功能损害加重5例,其中2例出现暂时性声音嘶哑,随访中好转。2例术后出现吞咽困难,1例有轻度面瘫。结论 根据肿瘤的生长方式,选择适当手术入路,可通过手术切除颈静脉孔区神经鞘瘤,并可获得良好手术效果。     

颈静脉孔区肿瘤的显微外科治疗

目的探讨颈静脉孔区肿瘤显微手术的临床疗效。方法分析近4年采用显微外科技术治疗颈静脉孔区肿瘤10例的临床资料．主要临床表现为听力下降和后组脑神经损害．术前行头颅核磁共振和颅底薄层CT扫描，8例行数字减影脑血管造影检查。采用显微外科手术切除．其中经颈静脉孔入路6例．远外侧入路2例，枕下乙状窦后入路2例。结果10例术中肿瘤全切除9例，次全切除1例。病理学示神经鞘瘤6例，神经纤维瘤1例，脑膜瘤1例，转移瘤1例，颅咽管瘤1例术后2例完全清醒后未及时行气管切开术而突发喉头水肿窒息死亡。存活8例磁共振复查显示肿瘤全切除7例，次全切除1例。8例术后症状改善3例，症状不变3例，症状加重2例。结论采用显微外科技术选择适当的手术入路可以较好地切除颈静脉孔区的肿瘤，经颈静脉孔入路可能是该区域肿瘤手术治疗的最佳入路。     

颈静脉孔区神经鞘瘤(附4例报告)

颈静脉孔区神经鞘瘤(jugular foramen neurinoma,JFN) 是罕见的颅内肿瘤,占颅内神经鞘瘤2.9%～4%,与听 神经瘤的发生率之比为1:24.首发症状常为听力下降,并 占居于桥脑小脑角[1～3],易误诊为听神经瘤.近期我们对4 例JFN病人经明确诊断后,采用远外侧入路和颞下窝入路 切除肿瘤.手术效果满意,报告如下.     

颈静脉孔神经鞘瘤的显微外科治疗

目的　研究颈静脉孔神经鞘瘤的手术切除效果。　方法　回顾性分析采用显微外科手术治疗颈静脉孔神经鞘瘤２０ 例,其中 Ａ 型肿瘤位于桥小脑角１２ 例; Ｂ型肿瘤原发于颈静脉孔,向颅内生长３ 例,采用乳突后枕下或后正中钩型切口开颅; Ｃ 型肿瘤位于颅外,并向颈静脉孔生长１ 例, Ｄ 型肿瘤由颈静脉孔向颅内外生长,呈哑铃型４ 例,取颈乳突联合入路。　结果　肿瘤全切除１１ 例,次全切除９ 例次,大部切除５ 例次,无手术死亡率。　结论　根据肿瘤生长方式选择良好显露肿瘤的手术入路是切除肿瘤的关键,而防止脑神经损伤是切除肿瘤的重要环节     

颈椎管哑铃形神经鞘瘤显微外科手术29例临床分析

目的 报道颈椎管哑铃形神经鞘瘤显微外科手术治疗的临床疗效. 方法 回顾性分析29例颈椎管哑铃形神经鞘瘤临床和随访资料.对其手术入路和显微外科手术技巧进行探讨. 结果 颈椎管哑铃形神经鞘瘤显微手术29例,其中经颈后入路手术23例,经颈前和颈后联合入路手术6例.手术全切除肿瘤28例,次全切除肿瘤1例.手术后神经功能改善21例,神经功能与术前相同8例.术后随访36.5个月,肿瘤全切除病例无肿瘤复发,全部病例颈椎稳定性良好. 结论 采用显微外科手术技术,选择合适的手术入路,在全切除颈椎管哑铃形神经鞘瘤的同时尽可能保留神经功能和颈椎自身的稳定性,能够取得较好的临床疗效.     

颈静脉孔区神经鞘瘤合并右侧声带麻痹围手术期管理1例

颈静脉孔区神经鞘瘤是最复杂的颅底肿瘤之一, 发病率低, 肿瘤组织常与神经、血管广泛紧密粘连。此类肿瘤患者术前常合并后组脑神经损伤, 手术创伤大、时间长, 术中需全面的神经功能电生理监测, 围手术期管理复杂。海军军医大学附属长海医院近日完成了1例在全麻下行右侧颈静脉孔区神经鞘瘤切除+颅骨修补术。现整理此病例围手术期管理体会, 以期为该类患者围手术期管理提供参考。     

Wiltes肌间隙通道切除腰椎间孔区神经鞘瘤

[目的]介绍Wiltes肌间隙通道切除腰椎间孔区神经鞘瘤手术技术和初步临床效果。[方法]对2例腰椎间孔区神经鞘瘤患者行上述手术治疗。依据术前影像确定手术入路与工作通道位置，由Wiltes肌间隙置入14 mm工作通道并直达椎板外缘表面，磨除部分椎板外侧峡，切除部分黄韧带，充分显露责任神经根及肿瘤膜性结构，沿肿瘤长轴纵向切开肿瘤包膜，并沿肿瘤边界膜内切除肿瘤。[结果] 2例患者均一期手术完整肿瘤切除，术后症状基本消失，次日可下床活动，随访17个月，未发现肿瘤复发及远期手术并发症。[结论] Wiltes肌间隙微通道手术可一期完整切除腰椎间孔区神经鞘瘤，避免术后脊柱不稳定和椎旁软组织损伤。     

海绵窦区神经鞘瘤的诊断及治疗

目的：探索海绵窦区神经鞘瘤的治疗方法。方法：22例MR确诊为海绵窦区神经鞘 瘤的患者经显微外科手术切除肿瘤,其中经颞-颧入路手术者14例,颞-枕经小脑幕入路手术者8例。结果：22例患者中21例（95.5％）肿瘤全切除,1例肿瘤次全切除。切除的肿瘤组织均经病理证实为神经鞘瘤。术后患者的头痛及突眼症状均有不同程度的减轻;外展神经功能障碍的19例中;12例术后3个月外展神经功能有不同程度的恢复;6例动眼神经麻痹患者,4例术后功能恢复;1例肢体活动障碍者恢复良好;并发脑积水者术后积水减少。所有患者术后均获随访,随访时间8-60个月,未见肿瘤复发。肿瘤次全切除的患者,术后3个月行γ-刀治疗,随访2年未见肿瘤复发。结论：经颞-颧或颞-枕经小脑幕入路行显微手术切除海绵窦区神经鞘瘤,可取得较好的疗效。     

椎间孔外侧神经根神经鞘瘤诊断与治疗

目的 探讨椎间孔外侧神经根神经鞘瘤诊断与治疗。方法 分析12例病人的临床表现、影像学特点。10例病人行前路或腹膜外入路，2例经椎弓峡部外缘进路切除肿瘤。结果随访4个月～6年，除1例死亡外(恶性神经鞘瘤)，10例1次手术治愈，1例颈2神经根肿瘤施行3次手术后治愈。结论 椎间孔外侧神经根神经鞘瘤依据临床表现、影象学检查可作出诊断，手术切除可取得满意疗效。     

前外侧或外侧硬脑膜外入路切除海绵窦区肿瘤

目的 提高海绵窦区肿瘤的全切率，降低神经功能的残障率。方法 回顾性总结了9例海绵窦内肿瘤，经前外侧或外侧硬膜外入路，通过显微神经外科技术切开海绵窦外侧壁夹层，按神经走行方向切开，辨认肿瘤生长和颅神经的关系分块切除肿瘤。结果 9例海绵窦内肿瘤中，其中海绵状血管瘤1例，神经鞘瘤6例，脑膜瘤2例。全切除5例，3例次全切除，1例大部分切除。3例出现新的颅神经功能障碍症状，6个月后新出现的颅神经功能障碍症状减轻2例，完全恢复1例。结论 明确的海绵窦区显微外科解剖概念，娴熟的显微神经外科技术以及选择适当的手术入路是提高海绵窦区肿瘤的全切率，降低术中出血、术后残障率的关键因素。     

An anatomical and technical note for neurosurgery of the jugular foramen tumor [author's transl)

The basic anatomy of the jugular foramen, some diagnostic principles of the jugular foramen tumors with presentation of our experiences of the 13 cases (6 neurinomas, 6 chemodectomas and 1 meningioma), and the detailed surgical technique used in their removal and its result are described. According to the extension of the tumor, one of the following operative approaches can be selected. A) Transjugular approach consists of a retromastoideal craniectomy following a radical mastoidectomy. The posterior wall of the jugular foramen is scraped out and the sigmoid sinus and the internal jugular vein are resected with the tumor either confined in the jugular foramen or extending out of the skull. B) Transjugular-transpetrosal approach is suitable for the tumor in the jugular foramen extending out of the skull as well as into the CP angle. The petrosal bone is more scraped out for removal of the tumor extending into the CP angle than in the above transjugular approach. In the case of the tumor extending into the CP angle and the upper clivus, the upper petrosal bone medial to the C-5-C-6 segments of the internal carotid artery are also removed and an extensive exposure of the intracranial tumor is obtained. C) A suboccipital craniectomy with retrolabyrinthine removal of the petrosal bone is suitable for large glosso-pharyngeal neurinomas extending into the CP angle but not out of the floor of the skull. In such cases, after removal of the CP angle tumor in the usual way, resection of the remaining jugular foramen tumor is easily performed through opening the petrosal bone forming the medial portion of the dome of the jugular fossa.     

Jugular foramen neurinomas.

Three patients with neurinomas of the jugular foramen are described. One of them had a small tumor confined within the jugular foramen and each of the other two had a tumor originating from the glossopharyngeal nerve. The common feature in all these patients was the presence of marked enlargement of the jugular foramen. Polytomography, jugular venography and bilateral retrograde vertebral arteriography were used to make the diagnosis. Total removal of their tumors was successfully accomplished using microsurgical technique. Forty-two other cases in the world literature are reviewed and analyzed.     

Intracranial neurinomas of the jugular foramen and hypoglossal canal

Intracranial neurinomas of the jugular foramen and the hypoglossal canal are relatively rare. Most reports have been of either single cases or of only two or three patients, and few large series exist in the literature. Although some of these tumors present palsies of the ninth, tenth, and eleventh cranial nerves as a jugular foramen syndrome, this is not always present. Unexpectedly, symptoms involving the eighth nerve are more frequently than those of ninth, tenth and eleventh nerves. This variability of clinical symptoms frequently leads to an initial misdiagnosis of glomus jugulare, acoustic or hypoglossal neurinoma. We report 2 cases of jugular foramen neurinomas and 2 cases of hypoglossal neurinomas. Our review of literature has tabulated 92 jugular foramen neurinomas and 34 hypoglossal neurinomas. These neurinomas had become considerably large in size by the time they were detected. So, we should endeavor, by clinical or neuroradiological finding to detect them at the early stage when they exert less influence on the brain. In this series we discuss clinical pictures of these neurinomas.     

颈静脉孔区巨大哑铃型肿瘤的显微外科治疗

目的 探讨颈静脉孔区巨大哑铃型肿瘤的治疗方法.方法 对10例颈静脉孔区巨大哑铃型肿瘤采用经颞下窝入路或改良枕下远外侧手术入路进行显微外科手术切除,并观察病死率、切除程度、术前术后的颅神经功能和脑脊液漏等主要并发症.结果 全切7例,次全切2例,部分切除1例.术后无一例死亡,脑脊液漏l例,术后出现新的神经功能损害1例,原有损害加重2例.术后9个月,80%的患者颅神经功能恢复,面神经功能1～2级(H-B分级)者7例,6例有残余听力者术后听力保存有3例,术后全切者复发1例.结论 采用颞下窝入路或改良枕下远外侧入路对颈静脉孔区巨大哑铃型肿瘤进行显微外科手术,术野暴露好,全切率高,并发症少,能较好的保护颅神经,术前受损颅神经功能有望恢复.     

Endoscope assisted removal of jugular foramen schwannoma; report of 3 cases.

Removal of the intraforaminal portion of a jugular foramen schwannoma under direct vision requires resection of the adjacent bone. Extensive resection of the bone around the jugular foramen, however, involves a potential danger for cerebrospinal fluid (CSF) leakage and for damage to the adjacent cranial nerves as well as venous outflow. To avoid such bone resection, we applied the endoscope during the removal of a jugular foramen schwannoma through the lateral suboccipital approach. Three patients with schwannomas in the jugular foramen were treated using the lateral suboccipital approach with endoscopic assistance. After the intracranial portion was first removed under the microscope, the residual tumor in the jugular foramen was subsequently removed under the side-viewing endoscope. In all cases the tumor was removed successfully without major complications. The authors conclude that if the cases are selected properly, removal of the schwannoma extending into the jugular foramen is feasible through the conventional lateral suboccipital window under endoscopic assistance.     

Jugular Foramen Schwannomas: Diagnosis and Suggestions for Surgical Management

Schwannomas arising in the parapharyngeal space are rare lesions; however, those originating in the jugular foramen are even less common. Two cases, each with marked intra- and extracranial extensions, are discussed. Clinical presentation and preoperative evaluation emphasizing computerized tomographic and magnetic resonance imaging will be presented. An aggressive two-stage surgical approach consisting of a retrosigmoid craniectomy combined with infratemporal removal is advocated for those lesions arising within the jugular foramen.     

Twelve Cases of Jugular Foramen Neurinoma

Twelve patients with jugular foramen neurinoma were operated on at our clinic between 1974 and 1990. The initial signs and symptoms were variable; dysfunctions of the 7th, 8th, 9th, 10th, and 11th nerves were frequently observed. Among these, involvement of the eighth nerve was most frequent, and three patients were given a misdiagnosis of acoustic neurinoma. Computed tomography scan and magnetic resonance imaging were useful not only for the correct diagnosis, but also for planning the surgical treatment and postoperative followup. Surgical resection was accomplished with four different approaches: (1) suboccipital approach without opening the jugular foramen, (2) suboccipital approach with opening the jugular foramen, (3) suboccipital approach with opening the jugular foramen combined with infralabyrinthine approach, (4) infralabyrinthine approach. The surgical approach depended on the presence of intracranial tumor and on the extent of extracranial involvement. There was no operative mortality. Dysfunction of the 8th, 9th, 10th, or 11th nerve did not improve in any patient after tumor removal. In contrast, 12th nerve palsy improved in two of three patients after tumor removal. The nerve of origin was identified in five cases; those were from the ninth nerve in three and from the 11th nerve in two.     

Jugular foramen schwannomas: diagnosis and suggestions for surgical management

Schwannomas arising in the parapharyngeal space are rare lesions; however, those originating in the jugular foramen are even less common. Two cases, each with marked intra- and extracranial extensions, are discussed. Clinical presentation and preoperative evaluation emphasizing computerized tomographic and magnetic resonance imaging will be presented. An aggressive two-stage surgical approach consisting of a retrosigmoid craniectomy combined with infratemporal removal is advocated for those lesions arising within the jugular foramen.     

Twelve cases of jugular foramen neurinoma

Twelve patients with jugular foramen neurinoma were operated on at our clinic between 1974 and 1990. The initial signs and symptoms were variable; dysfunctions of the 7th, 8th, 9th, 10th, and 11th nerves were frequently observed. Among these, involvement of the eighth nerve was most frequent, and three patients were given a misdiagnosis of acoustic neurinoma. Computed tomography scan and magnetic resonance imaging were useful not only for the correct diagnosis, but also for planning the surgical treatment and postoperative followup. Surgical resection was accomplished with four different approaches: (1) suboccipital approach without opening the jugular foramen, (2) suboccipital approach with opening the jugular foramen, (3) suboccipital approach with opening the jugular foramen combined with infralabyrinthine approach, (4) infralabyrinthine approach. The surgical approach depended on the presence of intracranial tumor and on the extent of extracranial involvement. There was no operative mortality. Dysfunction of the 8th, 9th, 10th, or 11th nerve did not improve in any patient after tumor removal. In contrast, 12th nerve palsy improved in two of three patients after tumor removal. The nerve of origin was identified in five cases; those were from the ninth nerve in three and from the 11th nerve in two.