中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2014年
7期
703-706
,共4页
陈海锋%李丹%吴虹刚%刘家刚%黄思庆
陳海鋒%李丹%吳虹剛%劉傢剛%黃思慶
진해봉%리단%오홍강%류가강%황사경
枕骨大孔%肿瘤%临床分型%显微外科手术
枕骨大孔%腫瘤%臨床分型%顯微外科手術
침골대공%종류%림상분형%현미외과수술
Foramen magnum%Tumor%Clinical classification%Microsurgery
目的 探讨枕骨大孔区肿瘤的临床分型及显微外科手术方式和技巧.方法 回顾性分析显微外科手术切除的102例枕骨大孔区肿瘤的临床资料,根据影像学资料对肿瘤进行临床分型:(1)腹侧型:肿瘤位于延颈髓腹侧(3例,2.9％);(2)外侧型:肿瘤位于延颈髓侧方(85例,83.3％);(3)髓内型:肿瘤位于延颈髓髓内(14例,13.7％).根据分型采用不同的手术方式一期切除肿瘤,其中腹侧型和髓内型采用枕颈后正中双侧入路;而外侧型则采用枕颈后正中单侧入路.结果 肿瘤全切除96例(94.1％),次全切除4例,部分切除2例.术后随访3个月～8年(平均3.6年),临床症状改善97例(95.1％),加重5例;复发4例,无发生脊柱畸形的病例.结论 根据枕骨大孔区肿瘤分型来选择手术方式,不仅能提高肿瘤全切率,而且有利于减少手术创伤,从而最大限度地维持枕颈交界区的稳定性.
目的 探討枕骨大孔區腫瘤的臨床分型及顯微外科手術方式和技巧.方法 迴顧性分析顯微外科手術切除的102例枕骨大孔區腫瘤的臨床資料,根據影像學資料對腫瘤進行臨床分型:(1)腹側型:腫瘤位于延頸髓腹側(3例,2.9％);(2)外側型:腫瘤位于延頸髓側方(85例,83.3％);(3)髓內型:腫瘤位于延頸髓髓內(14例,13.7％).根據分型採用不同的手術方式一期切除腫瘤,其中腹側型和髓內型採用枕頸後正中雙側入路;而外側型則採用枕頸後正中單側入路.結果 腫瘤全切除96例(94.1％),次全切除4例,部分切除2例.術後隨訪3箇月～8年(平均3.6年),臨床癥狀改善97例(95.1％),加重5例;複髮4例,無髮生脊柱畸形的病例.結論 根據枕骨大孔區腫瘤分型來選擇手術方式,不僅能提高腫瘤全切率,而且有利于減少手術創傷,從而最大限度地維持枕頸交界區的穩定性.
목적 탐토침골대공구종류적림상분형급현미외과수술방식화기교.방법 회고성분석현미외과수술절제적102례침골대공구종류적림상자료,근거영상학자료대종류진행림상분형:(1)복측형:종류위우연경수복측(3례,2.9％);(2)외측형:종류위우연경수측방(85례,83.3％);(3)수내형:종류위우연경수수내(14례,13.7％).근거분형채용불동적수술방식일기절제종류,기중복측형화수내형채용침경후정중쌍측입로;이외측형칙채용침경후정중단측입로.결과 종류전절제96례(94.1％),차전절제4례,부분절제2례.술후수방3개월～8년(평균3.6년),림상증상개선97례(95.1％),가중5례;복발4례,무발생척주기형적병례.결론 근거침골대공구종류분형래선택수술방식,불부능제고종류전절솔,이차유리우감소수술창상,종이최대한도지유지침경교계구적은정성.
Objective To explore the clinical classification,microsurgical operation methods and techniques of the tumors located at foramen magnum region.Methods 102 cases of foramen magnum tumors were resected by microsurgical operations in neurosurgery department of West China Hospital of Sichuan University from September 2005 to September 2013,and the clinical data of all cases were retrospectively analyzed.According to the results of clinical imaging,these cases with foramen magnum tumors were classified into 3 clinical types as follows:(1) Ventral type:tumor was located at ventral of medulla oblongata-cervical spinal cord,and there were 3 cases (2.9％) of meningioma belonging to such type; (2) Lateral type:tumor was located at lateral,ventrolateral or dorsolateral of medulla oblongata-cervical spinal cord,and there were 85 cases (83.3％) belonging to such type,including 35 cases of meningioma,48 cases of schwannoma and 2 cases of epidermoid cyst; (3)Intramedullary type:tumor was located in medulla of medulla oblongata-cervical spinal cord,and there were 14 cases (13.7％) belonging to such type,including 5 cases of ependymoma,7 cases of hemangioblastom a,and 2 cases of cavernous hemangioma.All cases of these foramen magnum tumors were resected in one-stage,and these tumors were resected by different microsurgical operation methods according to clinical classification.The tumors of ventral and intramedullary types were reseeted by posterior occipitocervical bilateral approach,while the lateral type by posterior occipitocervical unilateral approach.Results 96(94.1％) cases of foramen magnum tumors were totally resected,4 subtotally resected,and 2 partially resected.The follow-up period ranged from 3 months to 8 years (mean duration:3.6 years).The clinical manifestation was improved in 97(95.1％)cases,aggravated in 5,4 recurred and there was no spinal deformity.Conclusions Using the clinical classification of foramen magnum tumors to guide the choice of surgical approach not only improved the totally removal rate of tumors,but also helped to reduce the surgical trauma.Furthermore,it could maximally maintain the stability of the occipital-cervical junction area.
