岩斜区脑膜瘤的显微外科治疗(附18例报告)

目的提高岩斜区脑膜瘤的手术效果。方法回顾性分析我院自１９９５年１月至１９９７年１１月连续收治的１８例岩斜区脑膜瘤。１３例肿瘤大于４．５ｃｍ。采用了经颞下小脑幕、颞下－乙状窦前、颞下－迷路、枕下－极外侧入路。结果肿瘤全切除１１例（６１％）,其中２例术后发生Ｗｅｂｅｒ’ｓ综合征,１例死于肺炎。结论影响手术预后的最主要因素是小脑前下动脉（ＡＩＣＡ）、小脑上动脉（ＳＣＡ）和小脑后下动脉（ＰＩＣＡ）及其供应脑干的穿通支被肿瘤包裹和脑干受累,血管因素可能更为重要。     

动态增强MRI在鼻咽癌斜坡改变中的初步应用

目的了解正常、鼻咽癌(NPC)侵犯及放疗后纤维化的斜坡动态增强MRI特点,为进一步鉴别斜坡部位NPC放疗后复发与纤维化奠定基础.资料与方法 47例斜坡分为3组:正常斜坡(正常组)、NPC侵犯斜坡(NPC组)及斜坡放疗后纤维化(RF组).常规鼻咽部MRI平扫后,行动态增强MRI检查.动态增强后,行常规增强T1WI扫描.测量动态早期斜坡、原发肿瘤、髁突、鼻甲的相对信号强度并作出动态曲线.结果正常斜坡骨皮质呈完整的低信号,骨髓则呈低、混杂或高信号;动态早期(40 s时),3组斜坡相对信号强度有显著差异;3组斜坡的相对信号强度-时间曲线亦明显不同;NPC组斜坡相对信号强度明显较鼻甲高,但RF组相对信号强度较鼻甲低.结论动态增强早期强化特征及动态曲线有助于正常、NPC侵犯及放疗后纤维化斜坡的鉴别,值得在斜坡部位放疗后复发与纤维化鉴别中作进一步研究.     

Skull radiograph measurements of normals and patients with basilar impression; use of Landzert's angle

Summary One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2±2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9±2.7 mm (6–14 mm) above basal line in patients. The mean basal angle was 113±7 (102–133) in normals and 122±6 (113–125) in patients. The mean nasion-basion-opisthion angle was 162±4 (154–169) in normals and 178±5 (173–185) in patients. The mean total length of clivus was 48±3.7 mm (43–56 mm) in normals and 44±6.6 (36–48 mm) in patients group. The mean median diameter of the foramen magnum was 39±5 mm (30–48 mm), atlas 21±3 mm (18–25 mm) axis 18±3 mm (14–23 mm), third cervical vertebra 16±2 mm (13–22 mm) in normals and in patients: 39±4 mm (36–45 mm), atlas 23±6 (l5–30 mm) axis 19±4 mm (16–25 mm), third cervical vertebra 16±3 (14–20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

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Etude anatomo-radiologique de crânes normaux et de crânes pathologiques avec impression basilaire; utilisation de l'angle de Landzert

Résumé Cent crânes normaux ont été étudiés sur des radiographies de profil ainsi que dix crânes pathologiques présentant des impressions basilaires chez des patients traités à l'HÔpital Kenyatta de Nairobi. La plus courte distance moyenne entre le sommet de l'odontoÏde et la ligne basale de McGregor a été de 1,2±2,28 mm au-dessous de la ligne basale (extrÊmes étendues de 6 mm au-dessous à 3 mm au-dessus de la ligne basale), chez les sujets normaux et de 9±2,7 mm (6–14 mm) au-dessus de la ligne basale chez les sujets pathologiques. L'angle basai moyen était de 113±7 (102–133) chez les sujets normaux et 122±6 (113–125) chez les sujets pathologiques. L'angle moyen nasion-basion-opisthion était de 162±4 (154–169) chez les sujets normaux et 178±5 (173–185) chez les sujets pathologiques. La longueur moyenne totale du clivus était de 48±3,7 mm (43–56 mm) chez les sujets normaux et 44±6,6 (36–48 mm) chez les sujets pathologiques. Le diamètre moyen du foramen magnum était de 39±5 mm (30–48 mm), celui du foramen vertébral de l'atlas était de 21±3 mm (18 à 25 mm), celui de l'axis (18±3 mm (14–23 mm), celui de la troisième vertèbre cervicale: 16±3 mm (13–22 mm) chez les sujets normaux; chez les sujets pathologiques les chiffres étaient les suivants: foramen magnum 39±4 mm (39–45 mm), atlas 23±6 (15–30 mm), axis 19±4 mm (16–25 mm), troisième vertèbre cervicale 16±3 mm (14–20 mm). Il existe une différence significative dans la position du sommet de l'odontoÏde et la valeur de l'angle nasion-basion-opisthion entre les deux groupes. Aucun des autres paramètres mesurés dans ce travail ne présentait de différence significative entre les deux groupes.

     

Endoscopic-assisted transcolumellar approach to the clivus: an anatomical study

OBJECTIVE: Surgical exposure of the clivus and retroclival region is a challenging problem. Several extracranial and intracranial approaches using microsurgical techniques have been proposed in the search to optimize the exposure of the clival region. The objective of the present study was to develop an endoseopic-assisted transcolumellar approach to the anterior clivus. STUDY DESIGN: Experimental anatomic study. METHODS: The approach was studied in 10 consecutive cadaveric preparations. It included a preliminary external rhinoplasty technique with a septal displacement procedure, which gives a wide intranasal route to the posterior wall of the nasopharynx. By use of a drill system and instruments specially designed for endoscopic sinus surgery, the clivus and retroclival region were appropriately managed. Direct morphometric measurements were obtained during all steps of the procedure. RESULTS: The endoscopic-assisted transcolumellar approach developed in the present experimental study allowed a good exposure of the clivus area and anterior cranial-cervical junction. By performing a preliminary septoplasty, the nostrils were turned into a single passage with adequate space for endoscopic insertion and manipulation of one or two instruments. The authors were able to completely expose the posterior wall of the sphenoid sinus and clival dura after the thick bone of the vomer, the floor of the sphenoid, and the clivus were removed by a drill. Angled endoscopes provided a comprehensive view of the retrosellar area. CONCLUSIONS: The endoscopic-assisted transcolumellar approach, besides offering a wide opening for endoscopic management of the clivus, also allowed the surgeon to perform a double-handed procedure and to associate the use of a microscope if needed. The use of endoscopes, although lacking the three-dimensional view, gave a thorough and closer exposure of the surgical field with the advantage of a multiangled perspective.     

扩大经蝶入路手术治疗蝶斜区脊索瘤

目的 探讨采用扩大经蝶入路手术切除蝶斜脊索瘤的方法.方法 12例患者采用标准经鼻中隔蝶窦入路,先行切除经蝶入路视野内的肿瘤,然后调整Hardy扩张器方向指向斜坡方向,进行手术入路的扩大.根据术前影像学资料、术中"C"型臂监测、神经导航、神经内镜以及术者的经验决定斜坡骨质磨除或咬除的范围,直至显露正常骨质和硬脑膜,显微镜下切除肿瘤.结果 全切8例(67%),次全切3例(25%),部分切除1例(8%).结论 采用扩大经蝶入路手术治疗蝶斜区脊索瘤,显露满意、全切率高,无明显手术并发症.而神经导航、神经内镜的应用,使得该入路更为安全有效.     

Fibrous dysplasia of the clivus

The case of a 37-year-old man with monostotic fibrous dysplasia of the clivus is reported. This study includes clinical presentation, radiologic appearance, surgical findings, and pathology of this lesion. The significance of magnetic resonance imaging and management of this uncommon clival lesion are discussed.     

Clival chordoma in early childhood without bone involvement

Intracranial chordomas are rare in childhood. Only 15 cases have been reported in children less than 6 years old. Bone destruction and calcification have been stated to be characteristics of this tumor. We present the case of a 5-year-old boy with clival chordoma without bone involvement.     

Kawase入路切除上斜坡区肿瘤

目的　评价经Kawase入路切除上斜坡区肿瘤的适用性。方法　应用Kawase入路对 2 1例上斜坡区肿瘤患者进行了显微外科手术。结果　 2 1例中有 6例脑膜瘤和 8例三叉神经鞘瘤获得全切 ,4例脑膜瘤和 3例三叉神经鞘瘤获得次全切。术后 2例患者出现永久性动眼神经瘫 ,12例出现暂时性颅神经损害。结论　Kawase入路适用于处理上斜坡区肿瘤。该入路具有如下优点 :(1)可直接进入桥前池及其上方 ,无需牵拉小脑 ;(2 )可同时处理中、后颅凹的病变 ,路径较短 ;(3)在切除肿瘤之前即可分离出小脑幕动脉 ,阻断肿瘤部分血运 ;(4)保留听力 ;(5 )Labb啨静脉并发症较少     

鼻内镜下经鼻蝶斜坡脊索瘤的手术治疗

摘要：目的探讨鼻内镜经鼻蝶入路手术治疗斜坡区脊索瘤的手术方法和临床效果。方法2010年3月~2015年4月收治13例斜坡区脊索瘤患者,运用鼻内镜经鼻蝶入路切除位于颅底斜坡的脊索瘤,未能全切除者术后辅以放射治疗,杀灭残留的肿瘤组织。结果经鼻蝶内镜下全切肿瘤6例,次全切除4例,大部分切除3 例。术后临床症状得到不同程度改善10 例,无明显缓解3例,术后辅助放疗。随访3个月至4年,4例术后2年复发,行再次手术,1例出现脑脊液鼻漏,行漏口修补后好转出院,其余患者肿瘤无复发。术后3例患者症状无明显缓解,患者年龄大,一般情况较差,未再次行手术治疗。结论鼻内镜下经鼻蝶入路切除主要位于中,上斜坡的脊索瘤,手术入路短,术中深部结构辨认清晰,相对于其他手术入路,该入路创伤小、安全、用时少,疗效满意。是斜坡脊索瘤治疗的一种较好的手术入路。     

A case of Lemierre's syndrome with double vision as the first symptom

Lemierre's syndrome is a serious disease that typically causes oropharyngeal infection with internal jugular vein thrombosis, followed by distant infection focus, such as septic pulmonary embolism. The main causative organisms are anaerobic bacteria in the oral cavity, namely Fusobacterium necrophorum. We encountered an extremely rare case of Lemierre's syndrome, where double vision was found to be the first symptom. The patient's blood culture results showed the presence of F. nucleatum, which spread from the sphenoid sinus to the skull base because of chronic sinusitis; the patient presented with longus colli abscess, clivus osteomyelitis, venous thrombosis, and hematogenous infection. Antibiotic treatment with sulbactam/ampicillin was continued for 14 weeks, and no recurrence has been observed so far. Lemierre's syndrome can be complicated with atypical symptoms such as double vision if the cranial nerves are involved. It might be important to consider this disease in the differential diagnosis in the presence of cranial nerve symptoms of unknown origin with fever or inflammatory findings.