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。

Microsurgery via suboccipital retrosigmoid approach for cerebellopontine angle tumors with onset of trigeminal neuralgia and hemifacial spasm

Objective To explore the clinical effects of microsurgery via suboccipital retrosigmoid approach on the cerebellopontine angle (CPA) tumors with onset of trigeminal neuralgia (TN) and hemifacial spasm (HFS). Methods The clinical data of 21 patients with CPA tumor with onset of TN and HFS, who underwent surgery from September, 2014 to September, 2016, were analyzed retrospectively. The surgery via the suboccipital retrosigmoid approach for CPA tumors was performed in all the patients. Seventeen patients underwent microvascular decompression (MVD) for TN and HFS at the same time. Results The CPA tumors were totally removed in 18 patients and subtotally in 3. The clinical manifestations of TN and HFS disappeared or significantly decreased after the operation in all the patients. There were no serious complications such as hematoma, ischemia, acute hydrocephalus and death. During the follow-up from 3 to 27 months, no TN, HFS and tumor recurred in all the patients. Conclusions The CPA tumor may only manifest the symptoms and signs of TN or HFS and MRI examination can provide the information for its early diagnosis. The curative effects of the surgery via suboccipital retrosigmoid approach on CPA tumors with onset of TN and HFS are good. MVD is recommended if the vessels responsible for TN and HFS are found during the surgical resection of the tumor.