Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system
Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system
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DOI：
10.3171/jns/2008/109/11/0794
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发表时间：
2008-11-01
影响因子：
4.1
通讯作者：
Fukushima, Takanori
中科院分区：
文献类型：
--
作者：
Bulsara, Ketan R.;Sameshima, Tetsuro;Fukushima, Takanori
object.由于颈静脉孔神经鞘瘤邻近并累及重要的神经血管结构，切除颈静脉孔神经鞘瘤是一个巨大的挑战。作者回顾了颈静脉孔神经鞘瘤的显微外科治疗经验，并提出了一个改进的分级标准来指导手术治疗。所有颈静脉孔神经鞘瘤病例均由资深作者（T.F.）从1980年到2004年，我们回顾了。评估患者的平均就诊年龄、手术入路、肿瘤特征、颅神经（CN）缺损和肿瘤复发率。作者提出了以下改良分级量表：A型，硬膜内肿瘤; B型，哑铃形肿瘤;和C型。三重哑铃状肿瘤伴高颈延伸。作者在研究期间治疗了129例颈静脉孔肿瘤患者。这些。颈静脉孔神经鞘瘤53例（41%）。患者的平均年龄为52岁（范围14 - 74岁），有12名男性和41名女性患者。平均随访时间为8.4年。患者最常见的是迷走神经缺陷，其次是前庭/耳蜗神经和舌咽神经缺陷。48例患者（90.5%）实现了肿瘤的全切除。在先前正常的CN中未观察到新的术后轻瘫：然而，经常观察到术前CN缺陷恶化。发生率最高的是舌咽神经和迷走神经（30%），其中26%的缺陷是永久性的。该系列中没有与手术相关的死亡。3例患者（5.7%）出现肿瘤复发。结论。然而，颈静脉孔神经鞘瘤的显微手术切除有使术前CN缺陷恶化的风险。这些通常是暂时的。根据他们的经验，作者制定了一个分级量表，可以预测这些病变的最佳手术入路。需要大量的技术培训和该区域的显微神经解剖学知识。提出的改良gurading量表有助于术前计划。
Object. Due to the proximity and involvement of critical neurovascular structures, the resection of jugular foramen schwannomas can pose a formidable challenge. The authors review their experience in the microsurgical management of jugular foramen schwannomas and propose a modified grading scale to guide surgical management.Methods. All jugular foramen schwannoma cases treated by the senior author (T.F.)between 1980 and 2004 were retrospectively reviewed. The average age at presentation, surgical approach, tumor characteristics, cranial nerve (CN) deficits, and tumor recurrence rates were assessed. The authors present the following modified grading scale: Type A, intradural tumors: Type B, dumbbell-shaped tumors: and Type C. triple dumbbell tumors with a high cervical extension.Results. The authors treated jugular foramen tumors in 129 patients during the study period. Of these. 53 patients (41%) had jugular foramen schwannomas. The mean patient age was 52 years (range 14-74 years), there were 12 male and 41 female patients. The mean follow-up period was 8.4 years. Patients presented most commonly with deficits of the vagus nerve, followed by vestibular/cochlear nerve and glossopharyngeal nerve deficits. Gross-total resection of the tumor was achieved in 48 patients (90.5%). New postoperative paresis in a previously normal CN was not seen: however, worsening of preoperative CN deficits was frequently noted. The highest incidence occurred with the glossopharyngeal and vagus nerves (30%), with 26% of the deficits being permanent. There were no deaths related to surgery in this series. Three patients (5.7%) experienced tumor recurrence.Conclusions. The microsurgical resection of jugular foramen schwannomas carries a risk of worsening preoperative CN deficits however. these are often transient. Based on their experience, the authors have formulated a grading scale that predicts the optimal surgical approach to these lesions. Considerable technical training and microneuroanatomical knowledge of the region is required. The modified gurading scale presented facilitates preoperative planning.