颅底内外沟通性肿瘤的诊断及手术治疗

Transcranial Base Tumors: Classification, Diagnosis and Treatment

目的探讨颅底内外沟通性肿瘤来源分类、早期诊断及手术治疗方式。方法对我科1998年1月至2006年12月收治的53例颅底内外沟通性肿瘤患者均给予手术治疗,根据病情采用不同手术入路。结果肿瘤组织来源于颅外者35例,其中死亡25例(除手术死亡4例外,余21例平均生存时间为18月),10例仍生存;来源于颅内者15例,目前仅1例转移瘤于术后5月内死亡,其余生存良好。结论颅底内外沟通性肿瘤早期临床表现不明显,不典型三叉神经痛可能是信号之一,可以多学科联合手术,术中注意颅底水封性修补。该类肿瘤来源于颅外者恶性程度高,预后不良;来源于颅内者良性病变多见,预后较好;来源于颅底骨性结构者因病例较少,尚无法作出比较和判断。

Objective To explore the classification, early diagnosis and the surgical management of transcranial base tumors. Method The clinical data of 53 patients with transcranial base tumors, who underwent surgery in our department, were analyzed retrospectively. Results In early period, there was not obviously clinical manifestations and atypical trigeminal neuralgia might appear in the patients with transcranial base tumors. Of 35 patients with transcranial base tumors derived extracranially, 4 died during the treatment, 21 died during following up （mean survival time, 15 months） and 10 survived. Of another 18 patients, 15 with transcranial base tumors derived intracranially and 3 with tumors derived from cranial base bone. Of these 18 patients, 1 died 5 months after operation and 17 survived 3 years after the operation. Conclusions The transcranial base tumors derived extracranially are always malignant, most of the tumors derived intracranially are benign, and the tumors derived from cranial base bone are relatively uncommon. Early diagnosis of the transcranial base tumors is difficult due to lack of clinical manifestastion. Total resection of the tumors by microsurgery can improve curative effect on the patients with transcranial base tumors.