三叉神经鞘瘤的诊断和手术治疗

Diagnosis and surgical treatment of trigeminal neurinoma

目的探讨三又神经鞘瘤的临床特点、诊断及手术治疗方法。方法回顾性分析我院自1990年1月至2008年12月采用手术治疗的29例三叉神经鞘瘤的临床及影像学表现、手术方式及治疗效果。结果临床表现最常见为患侧三叉神经麻痹。肿瘤可位于中颅窝、后颅窝或骑跨中后颅窝呈哑铃形。本组中肿瘤全切除19例,次全切除7例,大部分切除3例。术后颅神经功能障碍较术前改善20例,无明显变化4例,加重5例,主要表现为面部麻木和眼球外展受限。结论三又神经鞘瘤起源部位和生长方向复杂。MRI对临床诊断及选择手术入路有重要意义。合适的手术入路及显微手术相结合能取得最佳治疗效果。

Objective To investigate the diagnosis and surgical treatment of trigeminal neurinoma. Methods The clinical manifestations, preoperative image features, surgical approach and outcome of 29 patients with trigeminal neurinoma performed the operation in our neurosurgery department between January, 1990 and December,2008 were analyzed retrospectively. Results The most common symptoms were the ipsilateral trigeminal paralysis. The tumors may locate in middle cranial fossa, posterior cranial fossa or extend into the middle and posterior cranial fossa as dumbbell-shaped. Total tumor removal were achieved in 19 patients, subtotal in 7, and largely partial in 3. Postoperatively, the cranial nerve deficits were improved in 20 patients, unchanged in 4 and worsened in 5 with facial numbness or the abducent nerve palsy. Conclusions The original location and developmental pattern of trigeminal neurinomas are complicated. MRI is important for diagnosis and surgical choice of approach. The combination of appropriate surgical approach and microsurgery can lead to better surgical results.