Surgical tactics and outcome of treatment injugular foramen schwannomas
Surgical tactics and outcome of treatment injugular foramen schwannomas
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颈静脉孔神经鞘瘤的手术策略及疗效
DOI：
10.1054/jocn.2001.0874
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发表时间：
2001
影响因子：
2
通讯作者：
Jong Hyun Kim
中科院分区：
文献类型：
--
作者：
Sang Koo Lee;Kwan Park;D. Kong;Yang;C. Baek;D. Nam;J. Lee;Seung;H. Shin;W. Eoh;Jong Hyun Kim
1995年至1999年间，三星医疗中心共收治7例颈静脉孔神经鞘瘤患者。排除神经纤维瘤病患者。回顾性分析了7例患者（6例手术病例和1例非手术病例）的记录。有6名女性和1名男性（平均年龄47岁），症状持续时间为3个月至14年（平均47个月）。主要症状为听力障碍、面肌痉挛和声嘶。术前听力学评估，计算机断层扫描（CT），磁共振（MR）成像和血管造影术在大多数患者进行。我们将肿瘤分为四种类型，使用Kaye和Pellet分类的基础上放射学和手术结果。肿瘤是：A型（桥小脑角）1例; B型（椎间孔）2例; C型（颅外和/或椎间孔）2例; D型（颅内外）2例。我们使用了各种手术入路，如A型肿瘤的乙状窦后枕下颅骨切除术，C型肿瘤的颞下窝A型入路（ITFA），D型肿瘤的岩枕经乙状窦入路或改良经耳蜗入路，以及B型肿瘤的ITFA和部分骨切除术。在选择手术入路时，我们考虑了肿瘤的范围、肿瘤的大小和术前听力功能。只有1例ITFA因肿瘤较小（1.5cm）而未行面神经移位术。五个病例实现了大体全切除，一个病例（D型肿瘤）通过一期手术实现了次全切除。在次全切除病例中，对残留肿块进行了立体定向放射外科手术。随访时间13 ~ 49个月，平均27.5个月。术后无死亡，随访MR成像也无复发。有2例暂时性面神经麻痹和1例既存低颅性麻痹加重。2例持续性声带麻痹行甲状腺成形术，无吸入性肺炎。腰大池腹腔分流术改善了持续性脑脊液收集。应根据其形态及临床表现选择合适的手术入路。一期手术效果满意。
Seven patients with schwannomas of the jugular foramen were included our study in Samsung Medical Center between 1995 and 1999. Patients with neurofibromatosis were excluded. The records of the seven patients (six surgical case and one nonsurgical case) were retrospectively reviewed. There were six women and one man (mean age, 47 years) with a symptom duration ranging from 3 months to 14 years (mean, 47 months). The predominant symptoms were hearing difficulty, hemifacial spasm and hoarseness. Preoperative audiologic evaluation, computerised tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in most patients. We classified tumours into four types using Kaye and Pellet classification on the basis of radiological and surgical findings. The tumours were: Type A (at cerebellopontine angle) in one; Type B (foraminal) in two; Type C (extracranial and/or foraminal) in two; and Type D (intra- and extracranial) in two cases. We used various surgical approaches such as retrosigmoid suboccipital craniectomy for Type A tumours, infratemporal fossa type A approach (ITFA) for Type C tumours, petro-occipital transsigmoid approach or modified transcochear approach for Type D tumours and ITFA with partial labyrinthectomy for Type B. In the selection of surgical approaches, we took consideration of tumour extension, tumour size, and preoperative hearing function. Facial nerve transposition was not used only in one case of ITFA because of small tumour size (1.5cm). Gross total removal was achieved in five cases, and subtotal removal in one case (Type D tumour) with a single-stage operation. Stereotactic radiosurgery was performed on residual mass in the subtotally removed case. Follow-up period ranged from 13 to 49 months (mean, 27.5 months). There was neither postoperative mortality nor recurrence on follow-up MR imaging. There were two cases of temporary facial nerve palsy and one aggravation of pre-existing low cranial palsy. Two case of sustained vocal cord palsy underwent thyroplasty, but there was no aspiration pneumonia. Persistent cerebrospinal fluid collection was improved with lumboperitoneal shunt. The surgical approaches of each case should be tailored according to their shape and the clinical manifestation. We obtain acceptable outcomes from one-stage operation.