三叉神经鞘瘤的诊断和治疗

DIAGNOSIS AND SURGICAL TREATMENT OF TRIGEMINAL SCHWANNOMA

目的探讨三叉神经鞘瘤的诊断和治疗方法。方法对我科1991年～1998年手术治疗并经病理证实的17例三叉神经鞘瘤进行回顾性分析。根据Jefferson的肿瘤分类方法：Ⅰ型（中颅窝型）3例，采用颞下入路和颞眶颧入路切除；Ⅱ型（后颅窝型）6例，采用额颞眶颧入路和枕下乳突后入路切除；Ⅲ型（哑铃型）8例，分别采用颞下入路、枕下乳突后入路和幕上、下联合入路切除。结果三叉神经鞘瘤临床上主要表现为三叉神经损害的症状和体征，早期进行CT、MR检查均可明确诊断，三叉神经鞘瘤应尽早手术治疗，并争取全切，以期根治。本组全切16例，次全切1例。10例门诊随访2年～5年无复发者。结论三叉神经鞘瘤早期进行CT、MR检查均可明确诊断，显微手术治疗是最佳方法，正确选择手术入路是肿瘤全切的前提条件。近年提倡颅底手术入路切除肿瘤。

Objective To probe the diagnosis and treatment for patients with trigeminal schwannoma (TS). Method A retrospective review of 17 patients with TS who surgically treated for 1991 to 1998 year in our hospital was carried out. All patients were verified by pathological examination. According to Jefferson TS classification: type Ⅰ：Tumors locate at the middle cranial fossa-3 cases; type Ⅱ：Tumors locate at the posterior caranial fossa-6 cases; type Ⅲ：Tumors locate at supra and infraten torial-8 cases. Different approaches were adopted in varied types. Results The main clinical manifestation of TS were the signs and symptoms of injured trigenminal nerve. This kind of tumor could be diagnose early by CT and MRI scan. Tumor should be excised as soon as soon as possible aftter diagnosis achieved. The key point for permant cure is total remoral of tumor. In our study,total removal were achieved in 16 caes, subtotal removal was achieved in 1 case. Fallow-up from two to five years, There was no recurrence in any case. Conclusion Early CT and MRI scans were important for diagnosis. The best treatment for TS is approach selected properly and microsurgery. At recent years, basic skull approach is the popular method for TS resection.