海绵窦海绵状血管瘤的手术疗效分析

Efficacy of surgical treatment for cavernous sinus hemangiomas

目的 分析海绵窦海绵状血管瘤的手术疗效.方法 回顾性分析2003至2009年手术治疗的29例海绵窦海绵状血管瘤.男7例,女22例,发病年龄（52±9）岁.临床表现：头痛15例,视力减退9例,复视7例,眼睑下垂2例,面部感觉异常6例,轻偏瘫1例,月经稀少4例.MRI为主要诊断方法.29例患者经额颞开颅伴或不伴眶颧弓切断,全部经硬脑膜下入路.结果 肿瘤全切除14例（48.3%）,近全切除13例（44.8%）,大部切除2例（6.9%）,无手术死亡病例.术后27例（93%）随访3个月至6年.头痛全部缓解,神经系统症状改善12例,内分泌症状无改善.主要并发症包括视力减退2例（6.9%）、动眼神经麻痹17例（58.6%）,外展神经麻痹8例（27.6%）,三叉神经麻痹4例（13.8%）.16例定期复查MRI,时间1至6年,未见肿瘤复发.结论 手术是治疗海绵窦海绵状血管瘤比较有效的方法,但全切除肿瘤难度较大,脑神经损伤等并发症仍然不容乐观.

Objective To analyze the efficacy of surgical treatment for cavernous sinushemangiomas （CSH）. Methods The data from 29 surgical CSH patients, 7 males and 22 females, aged 52 ± 9 years old, at our department were collected from 2003 to 2009 and analyzed retrospectively. The main presenting symptoms included headache （ n = 15 ）, impaired visual acuity （ n = 9 ）, diplopia （ n = 7 ）, ptosis （n=2）, facial paresthesia （ n = 6 ）, hemiparesis （ n = 1 ） and infrequent menstruation （ n = 4 ）. MRI was major preoperative modality. All patients underwent craniotomy via frontotemporal approach with or without orbitozygomatic osteotomy. The tumor was removed through intradural approach in all patients. Results Total removal was achieved in 14 （48. 3% ） patients. And 13 （44. 8% ） and 2 （6.9%） patients had subtotal and partial procedures respectively. No postoperative death occurred. Follow-up study of 3 months to 6 years was conducted in 27 patients （93%）. All headaches were relieved postoperatively. The central nervous symptoms improved in 12 patients. The neuroendocrine symptom had no improvement. The most common surgical complications included impaired visual acuity （ n = 2, 6. 9% ）, paralyses of oculomotor nerve （ n = 17,58.6% ）, abduct nerve （n = 8, 27.6% ） and trigeminal nerve （ n =4, 13. 8% ）. A MRI follow-up of 1-6 years was obtained in 16 patients without recurrence. Conclusion Surgery is an effective management strategy for CSH. However, total tumor removal remains difficult. Complications such as cranial nerve injury are still rather troublesome.