不同区域颅底肿瘤的组织来源特点及手术方案的选择

Tissue original characteristics and surgical operation selection in skull base tumor

目的:讨论不同区域颅底肿瘤的发生和组织来源的关系以及治疗方法的选择。方法:收集232例与颅底解剖区域有关的良、恶性肿瘤病例资料,分析哪些组织来源的肿瘤易接近或易侵犯颅底的哪些区域,不同区域的肿瘤选择了何种手术进路和治疗方法。结果:达颅前窝的肿瘤40例,其中上颌骨鳞癌23例、肉瘤7例、粘液瘤3例、造釉细胞瘤7例;达卵圆孔至茎突连线以外区域(包括颞下窝)70例,其中下颌骨升支部恶性肿瘤43例、腮腺恶性肿瘤复发者9例(腺样囊性癌4例)、耳颞区皮肤癌复发者3例、髁状突骨瘤及骨软骨瘤10例、神经来源肿瘤5例,达卵圆孔至茎突连线以内斜坡外侧区域114例,其中神经鞘瘤60例、脑膜瘤9例、肉瘤12例、低分化硬癌4例、颈动脉体瘤16例(指抵达颅底的部分病例)、腮腺来源肿瘤13例;枕骨大孔附近8例,其中脑膜瘤2例、脊膜瘤3例、神经鞘瘤3例。结论:在能够接近或破坏颅底组织的肿瘤中发现,肿瘤组织来源不同,易发区域也有所不同。因此根据肿瘤发生的区域,可以初步判断肿瘤的组织来源,有利于诊断和鉴别诊断,同时可以帮助选择较为合理的手术进路。

Objective：To discuss the relationship between tumor origin and occurrence in different areas of skull base and the surgical operation methods in this areas. Methods： Total of 232 cases were selected and studied on which kinds of tumor easy to encroach on different areas of base of skull and to these tumor which surgical program should be used. Results： The number of tumors which reached anterior cranial fossa was 40 cases which including maxillary bone squamous cell carcinoma（ 23 ） , fleshy tumor（ 7 ） , colloid tumor（ 3 ） , adamantinoblastoma （ 7 ）. The number of tumors which grew out of the line between foramen ovale and styloid process（ including fossa infratemporalis） was 70 cases which including ascending branch malignant tumor（ 43 ） , recurrence of parotid malignant tumor（9 ） （adenoid cystic carcinoma 4 cases ） , recurrence of skin cancer of temporal and ear region （3）. Condyle osseous tumor and osteochondroma （10）, tumors originated from nerves（5 ）. The number of tumors which grew into the line between foramen ovale and styloid process was 114 cases which including myoschwannoma （60） , durosarcoma（9）, neurosarcoma（12） , poorly differentiated cancer（4） , carotid body tumor（16） ,Tumors originated from parotid gland （13）. The number of tumor which reached proximally foramen magnum was 8 cases ：durosarcoma（2） , spinal meningioma（3 ） ,myoschwannoma （3）. Conclusion： Tumors which easy to encroach the base line of skull were different in origin and occurrence. And it is helpful to select a reasonable operation method according to tumor origin and occurrence.