三叉神经鞘瘤的外科治疗

Surgical treatment of trigeminal neurinomas

目的探讨三叉神经鞘瘤最佳外科手术入路。方法回顾性分析７５例三叉神经鞘瘤的临床资料和随访结果。按时间先后分为早期组和后期组进行对比。结果早期组（１９７８～１９８４年）应用常规硬脑膜内入路；后期组（１９８５～１９９５年）除颅后窝型应用枕下硬膜内入路外，均用颅底开颅硬脑膜外入路。早期和后期组肿瘤全切率分别为５８％（２０／３５）和８０％（３２／４０）（Ｐ＜００５），暂时和永久颅神经障碍分别为６３％，３７％和２８％，１０％（Ｐ＜００１）。结论除非肿瘤位于颅后窝，经颅底开颅硬膜外入路显微外科手术是切除三叉神经鞘瘤最好的方法。

Objective To investigate the best surgical approach to remove of trigeminal neurinomas (TNs). Methods 75 patients with TNs in Huashan Hospital were reviewed retrospectively. Results In early group (1978～1984) conventional intradural approaches were used, and in late group(1985～1995) an epidural approach via the skull base craniotomy was utilized.Total removal of was achieved in 58%(20/35)in the early group and 80% (32/40)( P <0 05) in the late group. Temporary or permanent cranial nerves morbidities were 62 7%, 37% in the early group and 28 1%, 10%( P <0 01) in the late group, respectively. Conclusions The best surgical approach with microsurgical technique for removal of TNs is epidural approach or epiduro transduro transtentorial approach via a skull base craniotomy except the tumor only confined to the posterior fossa.