三叉神经痛型巨型桥小脑角区胆脂瘤的治疗体会

目的探讨三叉神经痛型巨型桥小脑角胆脂瘤的发生机制、临床表现和治疗原则。方法回顾性总结43例以三叉神经痛为主要表现的胆脂瘤患者的临床表现、肿瘤生长部位与大小、手术入路与技巧、结果和术后并发症等资料。结果肿瘤全切32例,次全切除11例。所有患者均表现为同侧三叉神经痛。术中发现30例肿瘤将三叉神经包绕在瘤内。术后三叉神经痛均消失,面部感觉减退8例,加重3例,外展神经麻痹3例;2例脑脊液漏（2005年之前）,5例疑是无菌性脑膜炎。结论桥小脑角区巨型胆脂瘤与三叉神经痛的关系复杂且导致的三叉神经痛临床表现多不很典型,应采取手术治疗,根据肿瘤部位采用不同术式,术中根据肿瘤和周围结构的关系以确定是否全切,对于三叉神经压迫明显,或是被肿瘤紧密包裹、黏连者,可同时行三叉神经感觉根部分切断术,术后注意无菌性脑膜炎脑脊液漏等并发症。

A retrospective study for the treatment of giant cerebellopontine angle chelesteatoma presented as trigeminal neuralgia

Objective To explore the mechanism,clinical manifestation and therapy for giant cholesteatoma of the cerebellopontine angle presented as trigeminal neuralgia.Methods The clinical manifestation,location and size of the tumor,operative approaches and technique,results and complications of 43 patients with cholesteatoma presenting with trigeminal neuralgia as main manifestation were reviewed retrospectively.Results Total removal was achieved in 32 cases,subtotal removal in 11 cases.All patients showed ipsilateral trigeminal neuralgia.In 30 cases during microsurgery,tumor was found surrounding the trigeminal nerve.All trigeminal neuralgia were cured,with facial hypoesthesia in 8 cases and hyporesthesia in 3 cases,abducens nerve palsy in 3 cases,two cases of cerebrospinal fluid leakage（before 2005） and five cases of suspected aseptic meningitis.Conclusion The relationship between the giant cerebellopontine angle cholesteatoma and the trigeminal neuralgia was rather complex.The clinical manifestations of trigeminal neuralgia was not very typical.All patients should be taken to surgery.For the obvious trigeminal nerve compression,tightly wrapped tumor or adhesions,part of the trigeminal nerve sensory root rhizotomy could be simultaneously adopted.Postoperative aseptic meningitis and cerebrospinal fluid leakage should be closely watched.