枕骨大孔区肿瘤的手术入路及显微外科治疗

Surgical approach and microsurgical treatment of foramen magnum tumors

目的探讨枕骨大孔区肿瘤显微外科手术的方法和入路分析。方法自2005年2月至2008年3月应用显微外科技术切除枕骨大孔区肿瘤20例,其中脑膜瘤13例,皮样囊肿3例,神经鞘瘤2例,脊索瘤1例,脉络丛乳突状瘤1例。影像学检查17例肿瘤位于硬膜内,3例位于硬膜外,其中肿瘤位于枕骨大孔前方、前外侧12例,后、侧方8例,5例肿瘤骑跨于枕骨大孔。结果本组20例中,采用后正中入路7例,枕下外侧入路12例,经口咽入路1例。肿瘤全切除17例,次全切除2例,大部分切除1例,术后出现后组颅神经轻度麻痹2例,无手术死亡。结论枕骨大孔区肿瘤手术显微程度要求高,脑干、后组颅神经和血管保护尤为重要。手术入路应根据肿瘤位置及与脑干的关系来选择,枕下外侧入路对于处理前、外侧肿瘤是一项好的选择,而脑干被压于侧方的,即使肿瘤位于前腹侧也可选择后方入路。

Objective To discuss the surgical approach and microsurgical treatment of foramen magnum tumors. Methods Microsurgery for 20 patients with foramen magnum tumors were performed from February 2006 to March 2008. These cases comprised of 13 meningiomas, 3 dermoid cysts, 2 schwannomas, 1 chordoma, and 1 choroid plexus papilloma. Image showed that 17 tumors located intradurally and 3 extradurally, including 12 tumors in the ventralis and lateral side of the foramen magnum, 8 in the posterior-lateral side and 5 tumors involved both two sides of the foramen magnum. Results Among the 20 patients, suboccipital and lateral approach was adopted in 12 cases, posterior-central approach in 7 cases, and oral-pharyngeal approach in 1 case. Total removal was achieved in 17 cases, subtotal removal in 2 cases and great partial removal in 1 case. No dead case occurred. Conclusion The microsurgery of foramen magnum tumors demands the sophisticated surgical skills and good protection on the brain stem, cranial nerves and blood vessels. The choice of surgical approach is determined according to the location of tumor and its relation to brain stem. The suboccipital lateral approach can provide large field of operation and wide surgical exposure to the tumors in the ventralis and lateral side of the foramen magnum, while the posterior-central approach is still a good choice when the brain stem is pushed to the lateral side.