锁孔开颅术治疗三叉神经痛型桥小脑角区胆脂瘤

目的探讨采用锁孔开颅术处理三叉神经痛型桥小脑角区胆脂瘤的临床体会。方法回顾性总结35例三叉神经痛型桥小脑角区胆脂瘤患者诊治经过,所有患者采用经枕下乙状窦后锁孔开颅技术,并将30例常规开颅术组设为对照组,对其显微外科治疗方法、疗效及并发症进行对比分析。结果锁孔组35例患者均经MR确诊,术后三叉神经痛症状均消失,其中33例术后症状立即消失,2例术后1个月内逐渐消失,肿瘤全切除25例,残留少量包膜的近全切除10例。锁孔组手术持续时间(126±48)min,而常规手术组手术持续时间(216±66)min(t=2.536,P0.05)。锁孔组术中出血量(91.3±52.2)m L,而常规组术中出血量(186.3±65.4)m L(t=2.163,P0.05)。术后面神经功能评估采用House-Brackmann分级系统,锁孔组Ⅰ级32例,Ⅱ级3例,2例合并听力下降者在术后3个月内逐渐改善,常规组Ⅰ级25例,Ⅱ级5例(χ~2=4.158,P0.05)。术后听力评估采用美国耳鼻喉头颈外科学会(AAO-HNS)分级法,锁孔组A级33例,B级2例,常规组A级27例,B级3例(χ~2=5.167,P0.05)。跟踪随访3个月至5年症状无复发,无手术死亡病例。结论经枕下乙状窦后应用锁孔开颅术治疗三叉神经痛型桥小脑角区胆脂瘤是安全有效的。

Keyhole craniotomy for cholesteatmas in the cerebellopontine angle region presenting as trigeminal neural-gia

Objective To investigate the clinical utility of keyhole craniotomy for Cholesteatmas in the cerebello-pontine angle region presenting as Trigeminal neuralgia by using keyhole craniotomy. Methods Clinical data of 35 pa-tients with Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia was analyzed retrospec-tively. All patients received suboccipital retrosigmoid keyhole craniotomy. Thirty cases who received conventional craniot-omy group were served as control group. A comparative analysis was conducted to assess the difference between these two groups in microsurgical methods, effects and complications. Results All patients were confirmed with MR diagnosis. In keyhole group, all patients had no pain symptoms of trigeminal neuralgia after surgical operation. The symptoms disap-peared immediately in 33 cases and gradually disappeared in 2 cases within one month following keyhole craniotomy. The tumors were totally removed in 25 cases and almost completely in 10 cases. The surgical duration was shorten in key-hole group than in conventional group (126±48 vs. 216±66 min;t=2.536, P<0.05). The amount of bleeding was smaller in keyhole group than in conventional group (91.3±52.2 vs. 186.3±65.4 mL;t=2.163, P<0.05). Postoperative neurologi-cal function was assessed in House-Brackmann. In keyhole group, there were 32 cases in class Ⅰ and 3 in grade Ⅱ. Two patients had hearing loss which was improved gradually in three months. In conventional group, there were 25 cases in class Ⅰ and 5 in grade Ⅱ (χ2=4.158, P<0.05). Postoperative hearing evaluation (AAO-HNS) revealed that there were 33 cases in grade A , and 2 in grade B in the keyhole group, whereas there were 27 cases in grade A and 3 in grade B in the conventional group(χ2=5.167, P<0.05). There were no relapse of tumors and death during 3 month to 5 years follow-up. Conclusions The suboccipital retrosigmoid keyhole craniotomy is a valid choice for Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia.