CAJ | 학술논문

目的探讨颅底肿瘤手术中发生的三叉-心脏反射(TCR)的临床特征、相关因素和预后.方法回顾2009年10月至2011年12月首都医科大学附属北京天坛医院神经外科262例颅底肿瘤患者在全身麻醉下开颅手术中发生的TCR,并分析与TCR相关的肿瘤类型和手术入路以及术后并发症.结果 17例患者术中发生TCR(占6.5％).其中男8例,女9例,平均年龄40.5岁.肿瘤类型以神经鞘瘤最多,共11例(64.7％)；手术入路以枕下乙状窦后入路最多见,其次为中颅底经天幕入路,分别为11例和4例(共占88.2％).术中停止手术刺激后血压和心率恢复正常.术后过程顺利,术后无TCR相关的心血管系统并发症.结论 TCR可发生于颅底肿瘤手术中,尤其是神经鞘瘤切除术和枕下乙状窦后入路以及中颅底经天幕入路；正确识别和处理颅底肿瘤手术中的TCR则预后良好.
목적 탐토로저종류수술중발생적삼차-심장반사(TCR)적림상특정、상관인소화예후.방법 회고2009년10월지2011년12월수도의과대학부속북경천단의원신경외과262례로저종류환자재전신마취하개로수술중발생적TCR,병분석여TCR상관적종류류형화수술입로이급술후병발증.결과 17례환자술중발생TCR(점6.5％).기중남8례,녀9례,평균년령40.5세.종류류형이신경초류최다,공11례(64.7％)；수술입로이침하을상두후입로최다견,기차위중로저경천막입로,분별위11례화4례(공점88.2％).술중정지수술자격후혈압화심솔회복정상.술후과정순리,술후무TCR상관적심혈관계통병발증.결론 TCR가발생우로저종류수술중,우기시신경초류절제술화침하을상두후입로이급중로저경천막입로；정학식별화처리로저종류수술중적TCR칙예후량호.
Objective To investigate the clinical features,risky factors and outcome of the trigemino-cardiac reflex (TCR) during surgery for skull base tumors.Methods Two hundred and sixty-two neurosurgical patients with skull base tumors underwent general anesthesia and open surgery from October 2009 to December 2011 in department of neurosurgery of Beijing Tiantan Hospital.The occurrence of TCR and the type of tumor,the surgical approach as well as the postoperative complication relative to TCR was evaluated retrospectively.Results Seventeen patients occurred TCR events intraoperatively (6.5％).There were 8 men and 9 women with an average age of 40.5 years.Eleven of them (64.7％) underwent schwannoma surgery.Regarding with the surgical procedure,the suboccipital retrosigmoidal approach and the middle fossa transtentorial approach were most commonly associated with TCR in this series (88.2％).The heart rate and blood pressure returned to the patient's normal baseline level after cessation of the surgical manipulation.There was no TCR-relative complication in cardiovascular system.The postoperative course is uneventful in all 17 patients.Conclusions TCR may occur during surgery for skull base tumor,especially when performing schwannoma surgery and suboccipital retrosigmoidal or middle fossa transtentorial approach.Accurate recognition and management of TCR during skull base surgery often carry on favorable outcome.