应用枕下经颈静脉突入路显微手术切除颈静脉孔区肿瘤

目的回顾应用枕下经颈静脉突（STJP）入路手术切除的颈静脉孔（JF）肿瘤病例，探讨该入路的临床价值及适用范围。方法回顾总结自2000年1月以来STJP入路14例和枕下一颞下窝联合入路1例切除的JF肿瘤病人的临床资料、手术入路及术后随访情况。结果本组14例JF肿瘤中，1例肿瘤局限于JF区；5例肿瘤完全向颅内发展；8例肿瘤主体位于颅内，其中2例部分瘤体向下跨枕大孔进入颈椎管上部，6例部分瘤体经JF向外口处发展，呈哑铃型，后者中有2例向前累及颈动脉鞘。手术全切除10例；近全切除1例；次全切除3例。术后无1例发生脑脊液漏。13例（92．9％）患者未新增颅神经损害症状，1例术后出现短期患侧眼外展麻痹和面神经不全损害（HBⅢ级）。术后随访3-60个月（失访1例），病人术前颅神经损害均逐渐恢复或代偿，随访时无1例存在吞咽困难。1例肿瘤颅外部分发展至颞下窝咽旁间隙采用枕下-颞下窝联合入路的患者术后出现后组颅神经损害表现，伴短期切口脑脊液漏。鼻饲4个月时因水、电解质紊乱合并肺部感染死亡。结论STJP入路操作简便易行，无需磨除岩骨及轮廓化面神经管，不破坏迷路，对颅底骨质破坏较少，显露范围较广泛，适用于主体在JF区和向颅内发展的JF肿瘤切除。

Application of the suboccipital transjugular process approach for jugular foramen tumors

Objective To explore the clinical value and applicability of the suboccipital transjugular process(STJP)approach to jugular foramen(JF)tumors.Methods Retrospectively reviewing the patients with JF tumors which were removed through STJP approach(14 cases)or the combined suboccipital- subtemporal fossa approach(1 case)from Jan 2000.All their clinical materials,the process of operative approach and the follow-up results were carefully analyzed and summarized.Results Among the 14 tumors, 1 was located only at JF;5 developed totally inside posterior cranial fossa from JF.The main mass of the other 8 tumors remained inside posterior cranial fossa,but part of the tumors developed downward:2 grew into upper cervical canal and 6 grew outside of JF,looking like a dumbbell,among whom 2 invaded forward involving the carotid sheath.10 tumors were totally removed,1 nearly totally removed and 3 subtotally removed.No leakage of cerebrospinal fluid occurred after operation.13 cases(92.9%)hadn't any new cranial nerve injury after operation except 1 suffering from short-term ocular abduction palsy and moderate facial nerve paralysis.The patients were followed-up 3-60 months(1 case lost).All the preoperative impairments in cranial nerves have gradually relieved and no patient presents with dysphagia at the time of consultation.One patient with part of the tumor invading into parapharyngeal space of the subtemporal fossa was operated through combined suboccipital-subtemporal fossa approach and brought about new impairment in lower cranial nerves accompanied with a short-term leakage of cerebrospinal fluid in incision.She had been given nasal feeding until her death because of water-electrolyte disturbance with pulmonary infection at the fourth month after operation.Conclusions The STJP approach is easily operated without need to grind out petrous bone and skeletonize facial nerve canal.It allows a relatively extensive exposure and produces no damage to labyrinth and less defect to cranial base structure.Therefore,we think that it is more suitable for those jugular foramen tumors locating in JF region or with intracranial extension.