咽旁间隙肿瘤的诊断及手术入路选择

目的:探讨咽旁间隙肿瘤的诊断及手术入路的合理选择。方法:对45例咽旁间隙肿瘤患者的资料进行回顾性分析。患者均行CT及颈部彩超检查,部分患者行MRI或DSA检查。采用的手术入路分别为:颈侧切开入路35例,腮腺入路5例,颈颌入路2例,颞骨加腮腺入路3例。结果:45例患者中良、恶性肿瘤分别为37例(82.22%)和8例(17.78%),其中以神经源性及涎腺来源最为常见。应用CT、MRI和DSA明确肿瘤的位置、大小、形态、密度、强化程度及肿瘤与茎突和颈动脉的关系,作出术前诊断,其与术后病理诊断的符合率为80%(组织来源符合率)。37例良性肿瘤完整切除,1例淋巴管瘤术后1年复发,再次手术后无复发。8例恶性肿瘤中,2例为恶性混合瘤,1例随诊4年无复发,1例随诊3年,带瘤生存;2例滑膜肉瘤,1例随诊3年无复发,1例随诊2年无复发;1例鼻咽癌咽旁间隙转移,术后给予根治性放疗,随诊5年无复发;1例脊索瘤随诊3年,复发带瘤生存;1例低分化鳞状细胞癌随诊4年,死于肺转移;1例滤泡树突状细胞肉瘤随诊2年无复发;结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义。颈侧切开入路简便、安全、创伤小,是咽旁间隙肿瘤手术的最...     

联合进路手术切除巨大颈静脉球体瘤

目的：探讨巨大颈静脉球体瘤手术进路及治疗经验。方法：６例巨大颈静脉球体瘤，４例经三种不同联合进路手术治疗，其中３例术前行ＤＳＡ检查及选择性血管栓塞术，１例术后残灶接受了辅助性放射治疗。结果：４例手术患者中，１例于术后４年因脑溢血死亡，但ＭＲＩ及ＣＴ复查肿瘤未见复发；１例于术后４个复发；１例部分切除术后残灶于放疗后６个月复查无变化。结论：巨大颈静脉球体瘤联合进路术式有利完全切除肿瘤，而术前配合选择性     

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.     

颈静脉球瘤诊断与治疗(附8例报告)

目的 探讨颈静脉球瘤的临床特点、诊断要点及巨大颈静脉球瘤的手术治疗方法。方法 回顾性分析2000至2009年深圳市第二人民医院及山东大学齐鲁医院耳鼻咽喉科收治的8例颈静脉球瘤的病例资料。结果 8例患者中,男5例,女3例; 33～62岁;均为单耳病变,左耳2例,右耳6例;主要临床症状为搏动性耳鸣、声音嘶哑、听力下降和面瘫。临床表现结合CT、MRI等影像学检查可明确诊断。所有病例均经术后病理证实。按1979年Fisch分型,A型0耳,B型1耳,C型1耳,D1型4耳,D2型2耳。均给予手术治疗,2例行单纯乳突根治术,6例行颞颈联合入路彻底切除肿瘤。术中2例出现脑脊液漏均经硬脑膜修补后治愈;2例术后面瘫,1例经治疗后缓解,1例为永久性;原有声音嘶哑、搏动性耳鸣缓慢消失。随访6例,单纯乳突根治术2例中,1例随访5年未复发,1例失访;余5例中,有1例术后第2年复发,给予放射治疗; 2例随访7年,1例3年,1例2年,均未复发。结论 颈静脉球瘤易误诊;诊断主要根据病史、临床及影像学检查,其中影像学对确诊起重要作用。手术切除是目前治疗颈静脉球瘤最好的方式,入路的选择对于手术的成功起决定性作用。     

后鼓室入路手术切除鼓室体瘤

报告经后鼓室入路手术切除２例局限十中耳的颈静脉球体瘤的临床资料。对鼓室体瘤的早期诊断及术式进行讨论认为后鼓室进路根除鼓室体瘤为首选术式。     

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。     

咽旁间隙神经鞘瘤诊断及手术入路选择

目的探讨咽旁间隙神经鞘瘤的诊断与手术入路方式的选择。方法对咽旁间隙神经鞘瘤患者14例病历资料进行回顾性分析,术前根据CT和MRI判断肿瘤与扁桃体包膜距离关系及肿瘤主体位置考虑手术径路,与扁桃体包膜距离≤1cm、肿瘤主体突入到口内者行经口内径路,与扁桃体包膜距离1cm、瘤体主体突向外侧者经颈外径路,手术径路与肿瘤大小关系不大。经口内径路4例,颈外径路10例。结果所有患者均获得顺利手术,术后随访6个月～6年均未见复发。结论颈部CT、MRI及DSA是诊断及鉴别诊断的良好手段,手术径路取决于肿瘤与扁桃体包膜的距离及肿瘤主体位置,无论采取何种径路,均无严重的并发症。     

耳后发际入路内镜辅助第二鳃裂囊肿切除术与传统术式的对照研究

目的：与传统经颈入路比较,评价耳后发际入路内镜辅助第二鳃裂囊肿切除术的可行性和利弊。方法：前瞻临床对照研究,25例第二鳃裂囊肿,13例接受耳后发际入路内镜辅助手术;12例接受传统经颈入路手术。术前,影像学（B超、CT或MRI）评估囊肿大小、位置、毗邻,并行细针穿刺组织学活检明确病理。两组比较切VI长度、手术时间、术中出血量、术后并发症、切口美容效果等。结果：所有病例均顺利完整切除。内镜组切口长度、手术时间显著大于传统组（P〈0．05）;术后3个月,内镜组切口美容效果显著高于传统组（P〈0．01）。术后内镜组出现1例（7．7％）暂时性耳垂麻木,1例（7．7％）耳后发际皮瓣游离缘皮肤淤紫,均在术后1个月缓解。所有病例随访18～36个月（中位随访26个月）,未见复发。结论：耳后发际入路内镜辅助第二鳃裂囊肿切除术安全、可行。与传统经颈入路比较,优点为切口隐蔽、美容效果确切,并发症少。     

颈静脉球体瘤（附10例报告）

目的：探讨颈静脉球体瘤手术效果及临床治疗经验。方法：复习１９８５～１９９５年１０例颈静脉球体瘤手术病历，其中６例肿瘤直径〉５ｃｍ。结果：肿瘤均能满意地予以完整的切除，平均手术时间６ｈ，平均失血量８００ｍｌ，随访１～５年无复发，其中７例术后３年复查均正常。结论：现代影像学及显微手术的进步，使得完整切除大型颈静脉球体瘤成为可能，手术成功的着急在于认真的术前检查及准备，术中细致的止血措施及精心的术扣护理     

内听道型听神经瘤的外科治疗

摘要：目的探讨和总结内听道型听神经瘤的临床显微手术技巧,以期提高手术疗效。方法回顾性分析2007年8月~2015年8月期手术的34例内听道型听神经瘤患者临床资料,探讨手术操作技巧,并总结肿瘤切除程度、术后并发症及远期随访情况。结果34例患者均采用枕下乙状窦后入路,肿瘤最大径小于10 mm 11例,介于10~20 mm之间23例;肿瘤全切34例。无一例死亡。术后3个月轻度周围性面瘫2例,听力较术前下降17例。术后随访2年以上,听力较术前下降13例。结论乙状窦后硬膜下入路是切除内听道型听神经瘤的良好办法,磨除内听道后壁及锐性分离是操作核心。     

Long-term results of different treatment modalities in 37 patients with glomus jugulare tumors

The results of different forms of treatment of 37 patients with previously untreated glomus jugulare tumors were compared retrospectively. According to the Fisch classification system, 6 patients presented with class B tumors, 19 class C and 12 patients with class D. Twenty-eight patients underwent surgery and 9 patients had primary radiation therapy (to 50 Gy). In 20 of the surgical cases (71%), radical tumor removal could be achieved and required no further treatment over a follow-up period of 8.6 years (range 2–15 years). Incomplete tumor resection with postoperative radiation therapy resulted in progressive tumor growth in three cases. One patient in this group experienced subarachnoid bleeding that had to be managed by salvage surgery. After primary radiation therapy, glomus jugulare tumors were still evident on magnetic resonance imaging scans, but showed no signs of disease progression. As a result of our experience, we found that a one-stage radical tumor resection performed in collaboration by otologic surgeons and neurosurgeons was the best treatment for patients with large glomus jugulare tumors. Received: 9 April 1998 / Accepted: 21 December 1998     

Paragangliomas of the Head & Neck: the KMC experience

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin's Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.     

海绵窦区肿瘤的手术治疗

目的探讨海绵窦区肿瘤的手术入路方式。方法总结1995年~2004年以来经显微手术治疗的海绵窦区肿瘤23例,其中海绵窦原发肿瘤7例;毗邻侵及海绵窦的肿瘤16例,后者包括侵袭性垂体腺瘤7例,脑膜瘤6例,神经纤维瘤3例。回顾其术前CT及MRI特征、手术方法。结果23例海绵窦区肿瘤经显微手术治疗,全切8例,部分切除15例,效果良好,无死亡。结论海绵窦区手术是神经外科的难题,合适的手术入路和良好的显微手术技能是手术成功的关键。     

原发性咽旁间隙肿瘤67例回顾性分析

目的 分析原发性咽旁间隙肿瘤的临床特点及手术径路选择,探讨不同手术径路的优缺点及预后。方法 回顾性分析67例咽旁间隙肿瘤患者资料,所有患者术前均行CT和(或)MRI检查,三种手术路径分别为颈侧径路45例、口内径路20例、颈-腮径路2例。术后病理学检查明确诊断,对所有手术患者进行术后定期随访,随访时间8～110个月,中位随访时间45个月。结果 67例中良性肿瘤共59例(88.1%),恶性肿瘤8例(11.9%);24例(35.8%)患者出现术后并发症,其中颈侧径路20例(29.9%),口内径路3例(4.5%),颈-腮径路1例(1.5%),其中7例(10.4%)随访后好转。复发患者7例(10.4%),颈侧径路4例(6.0%),口内径路3例(4.5%)。结论 咽旁间隙解剖毗邻复杂,病理类型繁多,肿瘤以良性为主,治疗以手术切除为主。术前根据影像学检查结果,肿瘤大小及解剖关系决定手术径路。颈侧径路仍是咽旁间隙肿瘤切除的首选方法,但在肿瘤最大直径<6 cm并位于动脉内侧的良性肿瘤患者中,可考虑口内径路。     

颈静脉鼓室球瘤诊治经验

目的 总结颈静脉鼓室球瘤诊治经验体会。方法 回顾性研究病理证实的10例颈静脉鼓室球瘤患者的临床资料。结果 颈静脉球瘤3例，鼓室球瘤7例。功能性颈静脉球瘤1例。家族性副节瘤1例。主要症状为搏动性耳鸣和听力下降，其他症状包括面瘫、眩晕、耳痛、吞咽困难、声嘶、咽部疼痛、阵发性高血压伴剧烈头痛、心悸。主要体征为鼓室内樱桃红肿物影和外耳道红色新生物，其他体征包括Brown征、上颈部包块、咽侧壁饱满隆起、Collet-Sicard综合征、Homer征和三叉神经受损。影像学检查包括颞骨薄层CT检查9例，颈动脉血管造影4例，MRI检查1例。耳鼻咽喉科8例，首诊其他科室2例。治疗：术前栓塞2例，单纯手术6例，手术 术后放射治疗4例。10例中随访9例，随访时间2～19年，中位随访期12年。6例肿瘤全切的鼓室球瘤患者无复发，3例次全切 术后放射治疗患者局部控制。1例失访。结论 颈静脉鼓室球瘤容易误诊，典型的临床表现结合影像学检查有助于诊断。要注意功能性和家族性颈静脉鼓室球瘤。鼓室球瘤应首选手术治疗，必要时可补充放射治疗。颈静脉球瘤，应该手术和放射治疗联合治疗。     

颈静脉鼓室球瘤的治疗

目的 探讨颈静脉鼓室球瘤的手术方法。方法 回顾性分析１９８２～１９９８年１１例手术治疗的颈静脉鼓室球瘤（鼓室球瘤Ⅱ型１例、Ⅲ型１例及Ⅳ型３例;颈静脉球瘤Ⅰ型１例、Ⅲ型５例）术式及治疗效果。结果 肿瘤均予以完全切除,术后均一期愈合。１例术后喉返神经麻痹。术后随诊１～８年,平均３年９个月,无复发者。结论 鼓室球瘤宜采用耳一切口入路;颈静脉球瘤Ⅰ型采用耳后切口向下延长至颈部,Ⅲ型采用耳后大Ｃ形切口行颞骨     

Facial paralysis associated with glomus jugulare tumors.

OBJECTIVE: To review the intraoperative findings and facial nerve management in nine patients who presented with facial paralysis associated with glomus jugulare tumors. STUDY DESIGN: A retrospective analysis of patient medical records. SETTING: Tertiary care academic medical center. PATIENTS: All patients who presented with facial paralysis and a glomus jugulare tumor who underwent surgical resection of their tumors at our institution. INTERVENTION: A postauricular infratemporal fossa approach for tumor removal and greater auricular interposition neural repair. MAIN OUTCOME MEASURE: Intraoperative facial nerve findings and long-term facial recovery. RESULTS: One hundred two patients underwent a postauricular infratemporal approach for resection of glomus jugulare tumor from July 1988 through July 2005. Nine of these patients presented with ipsilateral facial paralysis. The medial surface of the vertical segment was invaded by tumor in all nine cases. Facial recovery at 2 years was House-Brackmann Grade III in eight patients and Grade IV in one individual. Facial recovery did not significantly change after 2 years (mean follow-up of 7.4 years). DISCUSSION: Facial nerve invasion of the vertical segment occurred in 9 (9%) of 101 patients in our series. Facial nerve resection with interposition grafting resulted in House-Brackmann Grade III in eight (89%) of nine patients. Facial nerve dissection and preservation was not possible when preoperative facial paralysis was evident.