应用改良的远外侧入路显微切除颈静脉孔区巨大哑铃型肿瘤

背景与目的:运用基础远外侧入路切除颈静脉孔区肿瘤,颅内部分显露较好,避免了颞骨岩部的磨除,面神经的移位,不影响患者的听力,但当肿瘤向脑干腹侧和中颅凹发展且颅外肿瘤较多时,该入路就显不足了.本研究探讨经改良的远外侧入路显微切除颈静脉孔区巨大哑铃型肿瘤的手术方法和临床价值.方法:回顾分析2001年1月至2008年12月经改良的远外侧入路(枕下经颈静脉-颈静脉结节-颈静脉突)手术的16例颈静脉孔区巨大哑铃型肿瘤患者的手术方法,术前、术后临床资料.结果:手术全切除14例,近全切除1例,部分切除1例.随访3个月到7年,在术后的随访中10例(76.9%)后组颅神经受累患者的症状明显改善,术前面瘫(House-Brackmann 2～3级)的患者中8例(80.0%)术后获得不同程度的缓解.术前听力受损的9例患者7例(77.8%)术后有不同程度的恢复.有2例新增后组颅神经受损,在3个月随访中能基本代偿,有1例出现原有症状加重,出院时仍鼻饲流食.结论:对于颈静脉孔区巨大哑铃型肿瘤,特别是有向岩斜区及桥延交界腹侧发展的,采用改良的远外侧人路可获得较高的全切率,术前受损的颅神经功能有望恢复,且可保护面神经、迷路和椎动脉等结构免受不必要的损伤.

Microsurgery via modified far-lateral approach for giant dumbbell-shaped jugular foramen tumors

Background and Objective:During the resection of jugular foramen tumors via the basic far lateral approach,the jugular foramen tumor area as well as its adjacent structures,especially the intracranial part,can be better exposed,which avoids stripping of the petrous part of temporal bone and displacement of facial nerve,and protects the patient's hearing from damage.However,when applied in tumors developed from ventral to the brain stem and middle fossa,with extracranial tumors,this surgical approach seems t...