CAJ | 학술논문

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.
배경여목적:운용기출원외측입로절제경정맥공구종류,로내부분현로교호,피면료섭골암부적마제,면신경적이위,불영향환자적은력,단당종류향뇌간복측화중로요발전차로외종류교다시,해입로취현불족료.본연구탐토경개량적원외측입로현미절제경정맥공구거대아령형종류적수술방법화림상개치.방법:회고분석2001년1월지2008년12월경개량적원외측입로(침하경경정맥-경정맥결절-경정맥돌)수술적16례경정맥공구거대아령형종류환자적수술방법,술전、술후림상자료.결과:수술전절제14례,근전절제1례,부분절제1례.수방3개월도7년,재술후적수방중10례(76.9%)후조로신경수루환자적증상명현개선,술전면탄(House-Brackmann 2～3급)적환자중8례(80.0%)술후획득불동정도적완해.술전은력수손적9례환자7례(77.8%)술후유불동정도적회복.유2례신증후조로신경수손,재3개월수방중능기본대상,유1례출현원유증상가중,출원시잉비사류식.결론:대우경정맥공구거대아령형종류,특별시유향암사구급교연교계복측발전적,채용개량적원외측인로가획득교고적전절솔,술전수손적로신경공능유망회복,차가보호면신경、미로화추동맥등결구면수불필요적손상.
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 to be inadequate and limited.This study was to explore the microsurgical technique and clinical value for treating giant dumbbell-shaped tumors at jugular foramen(JF) via a modified far lateral approach. Methods: A retrospective analysis was performed in 16 patients with huge dumbbell shaped tumors at JF which were removed through the modified far lateral approach(suboccipital transjugular-jugular tubercle-jugular process)between January 2001 and December 2008.The process of operation, and pre-and postoperative clinical data were included in the analysis.Results:Gross total tumor removal was achieved in 14 cases, subtotal removal in 1 case, and partial removal in 1 case. Follow-up examinations in most patients demonstrated that the patient with an obvious preoperative deficit had a good recovery.During the follow-up from three months to seven years,10(76.9%) cases with lower cranial nerve involvement showed obvious improvement of symptom after operation.8(80.0%)cases with facial palsy obtained various degrees of alleviation, and 7(77.8%) cases with hearing impairment at different levels restored hearing.Two patients developed new lower cranial nerve palsies after operation, and underwent functional rehabilitation in the three-month follow-up.Conclusions:Modified far lateral approach is helpful forremoving the huge tumors at JF, especially for tumors extending to the petroclival region ventral part of pontomedullary junction.It has a higher rate of tolal resection,preoperative cranial nerve function impairment is expected to restore,and also has the advantage of protecting the facial nerve,labyrinth and vertebral artery structure from unnecessary damage.