颈静脉孔区神经鞘瘤的诊断和治疗

Diagnosis and treatment of jugular foramen neurinomas

目的总结颈静脉孔区神经鞘瘤的临床特点和手术方法。方法14例颈静脉孔区神经鞘瘤患者术前应用CT、核磁共振成像(MR I)和数字减影血管造影(DSA)进行诊断;应用远外侧入路手术切除肿瘤,并行三维CT血管成像术(CTA)模拟手术入路9例。结果术中证实,术后病理确诊颈静脉孔区神经鞘瘤。肿瘤全切除8例,次全切除4例,大部分切除2例。术后患者临床症状均较术前明显改善。结论肿瘤的诊断、分型及三维CTA的模拟对手术入路选择具有一定意义,选用远外侧入路能良好显露、切除该区神经鞘瘤。

Objective To study the clinical features and treatments of jugular foramen neurinomas. The approximate approach and proper exposure regions of jugular foramen tumour were discussed in this paper. Methods Fourteen cases of jugular foramen neurinomas were diagnosed by CT, MRI, DSA and 3DCT reconstruction preoperatively. The tumours were resected by far lateral infratemparal approach. The classification and relative operative approachs were discussed. Results Among 14 patients, total removal were achieved in 8 cases, subtotal removal in 4 cases and partial removal in the other 2 cases. All patients got good recovering. No serious complications correlating the approachs occurred except one case of facial paralysis. Conclusion The far later infratentorial approach was suggested to be more suitable for surgery upon neurinomas of jugular foramen.