中枢神经系统副神经节瘤的诊断与治疗

目的 探讨中枢神经系统副神经节瘤的诊断和治疗特点。方法 1976－999年手术治疗17例副神经节瘤,其中厮静脉球瘤11例,椎管内转移性副神经节瘤2例,颈动脉体瘤、鞍区副神经经节瘤、颞骨副神经节瘤及顶叶转移性副神经节瘤各1例。术中采用系统动脉压降压3例,亚低温麻醉1例;术前行血管内栓塞治疗7例;术后联合普通放疗5例,联合γ－刀治疗2例。结果 肿瘤全切除11例,次全切除例,大部切除3例。术后10d死亡1例,远期随访6个月－6年,1例格拉斯哥预后评分（GOS）3分,其余均4－5分。结论 临床表现结合影像学特点有助于临床诊断。手术全切除肿瘤为治疗首选方案,术后复发率低;术前栓塞应作为常规辅助治疗,可有效控制术中出血;术后放射治疗可控制残留肿瘤的生长。

Diagnosis and treatment of paragangliomas in the central nerve system

Objective To explore the diagnosis and treatment of paragangliomas in the central nerve system. Methods 17 patients with paragangliomas in the central nerve system over a 20-year period (1976-1999) were analyzed retrospectively. They included 11 patients with glomus jugular tumors, 1 with carotid body tumor, 1 with supersellar paraganglioma, 2 with spinal involvement, and 2 with superficial hemisphere involvement. Results Neoplasm was completely resected in 11 patients, subtotally in 3, and partial in 3. The postoperative mortality was 1/17. One patient remained severe disability, yet the others had excellent long-time outcome. Conclusions Both the characteristic clinical presentation and neuroradiological manifestation were useful for preoperative diagnosis. Total resection is ideal for paragangliomas. Preoperative embolization should be used routinely to control intraoperative bleeding, and postoperative radiation-therapy would be valuable to control the recurrence of the remaining tumor.