三叉神经鞘瘤的分型及手术入路的选择

Classification and surgical approaches of trigeminal schwannomas

目的探讨三叉神经鞘瘤的诊断治疗及肿瘤的分型和手术入路的关系。方法回顾分析156例经手术和病理证实的三叉神经鞘瘤的临床特点、分型、手术入路及预后。结果面部感觉减退或异常和头痛头晕是最常见的临床表现，平均病程29．3个月，术前KPS评分平均79．70±8．10。颅眶型7例，海绵窦型48例，颞下窝型19例，后颅窝型11例，岩尖骑跨型71例。全切除145例（92．9％）、近全切除11例、无手术死亡。随访到131例患者（84．0％），平均随访35．5个月，124例正常生活（94．7％）。结论根据肿瘤的分型及生长方式选择合适的手术入路，可在最大限度切除肿瘤的同时，保护脑神经的功能，获得良好的手术效果.

Objective To investigate the diagnosis and treatment of trigeminal sehwannoma （TS） as well as the relationship between its classification and surgical approaches. Methods The clinical features, classification, surgical approaches and prognosis of 156 consecutive cases of TS operated in the Skull - base ward of the department of neurosurgery in Beijing Tiantan hospital between July 1993 and November 2007 were reviewed. Results Facial hypoesthesia, headache and dizziness （38.5%） were the most common symptoms, and the mean duration was 29. 3 months. The preoperative KPS was 79.70 ± 8. 10. This serial cases were classified as cranioorhital type （7 cases）, type of cavernous sinus（48 cases ）, type of infratemporal fossa（ 19 cases）, and type of posterior fossa（ 11 cases） type of petrous apex （71 cases） . Gross total resection was achieved in 145 patients, and subtotal resection in 11 cases. There was no death in this group. Follow - up data were available for 131 patients （84. 0% ）, with a mean follow - up duration of 35. 5 months. 124 （94. 7% ） patients lived a normal life. Conclusions The most suitable approach of TS is closely interrelated with the classification and extension of tumors. Thus the maximum removal of tumors, protection of the function of cranial nerves as well as good prognosis could be achieved.