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.

Microsurgical treatment of gigantic dumbbell-shaped jugular foramen tumor

Objective To discuss the method of miernsurgical treatment for jugular foramen tumor (JFT).Methods Ten patients with dumbbell-shaped JFTs who were mireosurgically treated by the same group were retrospectively studied,the surgical approachs includes infratemporal approach and modified far lateral approach according to tumors'size,blood feeding,hearing and growth manner.Cranial nerve function,pre-and postoperative complications,follow-up data were presented and discussed.ResultsGross total tumor removal was achieved in 7 patients,subtotal removal in 2 cases,partial removal in 1 cage,postoperative cerebrospinal fluid leaking in 1 cases,postoperative new cranial nerve defects in 1 cases,aggravation in 2 cases.Postoperative deftcits of the cranial nerves improved in 80 percent of the patients.Favorable facial function in 6 months postoperatively(House-Brackmann grade system in Grade 1 and Grade 2)was noted in 7 of the 10 patients.The postoperative level of hearing was preserved in 3 of the 6 patients with residuary hearing.Recurrence was noted in 1 case during the follow-up period.Conclusions Surgical total removal of JFT is possible depends on micrnsurgical operation with the two approaches with lowly additional neurological deficits.The function of preoperative affected cranial nerves canl be recoveried.