颈静脉孔区颅内-外沟通瘤的手术治疗

Surgical Treatment for Intra-and Extracranial Tumor at Jugular Foramen Area

目的：总结、探讨远外侧经颈静脉孔入路治疗颈静脉孔区颅内-外沟通瘤的手术方法和注意事项.方法：对17例颈静脉孔区颅内-外沟通瘤患者采用远外侧颈静脉孔入路切除肿瘤.结果：患者肿瘤全切除13例,近全切除3例,次全切除1例.术后患者功能障碍大多明显改善.10例患者获临床和MRI随访3～42个月,未见肿瘤残留和复发.结论：采用远外侧经颈静脉孔入路可以充分暴露颈静脉孔区,利于手术同时切除颅内-外肿瘤.采用从颈静脉孔上、下两端分离肿瘤的手术方法,可保持肿瘤包膜完整,是减少颈静脉（球）和神经损伤、防止肿瘤残留的关键.根据DSA或MRV显示,结合术中判断乙状窦闭塞的情况切开乙状窦.手术结束时须严密缝合硬脑膜。

The surgical strategy and technique for treating intra- and extracranial tumors at jugular foramen area by far lateral transjugular approach were explored. Methods. Seventeen patients with intra- and extracranial tumors at jugular foramen area underwent operation to remove tumors by far lateral transjugular approach. Results. Thirteen tumors obtained total removal, three tumors obtained near total removal, one obtained subtotal removal. Most of the patients had greatly recovered from their dysfunction after operation. No residual or recurrent tumor was found at 3 to 42 months follow-up with MRI in 10 patients. Conclusion ： The far lateral transjugular approach has been found to be helpful for exposuring and removing the intra- and extracraninal tumors totally at one time. Tumors were dissected extracranially and intracranially at jugular foramen area respectively. It is crucial to properly keep the tumor intact for completely removing the tumor and minimizing the injury of jugular bulb and the low cranial nerves. The sigmoid sinus could not be opened until it was verified occulted by examination of DSA and MRV preoperatively, along with the judgment of the operator during the operation. The dura should be completely closed at the end of the procedure.