内镜经口入路颈静脉孔区神经鞘瘤切除术

Surgery for jugular foramen schwannomas via a pure endoscopic transoral approach

目的探讨内镜经口人路切除颈静脉孔区神经鞘瘤的可行性及效果。方法采用单纯内镜经口入路切除9例颈静脉孔区神经鞘瘤，其中男3例，女6例；年龄15～61岁；临床表现：舌下神经麻痹8例次，迷走神经麻痹6例次，舌咽神经麻痹3例次，面神经麻痹1例次，听力下降1例次。结果9例颈静脉孔区神经鞘瘤均获得完全切除，且保留了该区域的颅神经功能。除1例患者术后出现暂时性吞咽困难及患侧迷走神经麻痹的并发症外，未见其他并发症发生。9例患者术后随访4—29个月，平均14．3个月，所有患者迷走神经和舌咽神经麻痹均得到了改善和恢复，面神经麻痹和听力下降得到了恢复，舌肌运动获得了改善，但半舌萎缩无明显变化。结论内镜经口入路可以安全、彻底、微创地切除颈静脉孔区神经鞘瘤，并且能够保留和改善后组颅神经功能。

Objective To report a new approach, endoscopic transoral approach for the resection of jugular foramen schwannoma. Methods Nine patients with jugular foramen schwannoma （three males and six females, ranging in age from 15 to 61 years old ） were treated by direct surgery via a pure endoscopic transoral approach to the jugular foramen. Eight patients complained of hypoglossal nerve palsy with hemiatrophy of the tongue; six cases complained of vagus nerve palsy. Three cases complained of glossopharyngeal nerve palsy, one case complained of facial nerve palsy and hearing loss. Results The nerves in this area were preserved and radical intracapsular removal of the tumor was performed via endoscopic transoral approach in the nine cases. Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed all tumors were completely removed. One patient suffered from temporary swallowing difficulties and temporary right vagus palsy 1 day after surgery. There were no others intraoperative and postoperative complications. All patients were followed up for 4 - 29 months, no recurrences were occured in all these patients and the muscle bulk, motor and the pre-postoperative swallowing ruction, the vagus palsy, the facial nerve palsy and hearing loss had improved in these patients. Conclusion The endoscopic transoral approach and intracapsular removal of the tumor provided for successful minimally invasive surgery in the jugular foramen schwannomas.