引起脑干受压胆脂瘤的临床评价

Clinical evaluation on cholesteatoma of compressing brain stem

目的探讨引起脑干受压的胆脂瘤的临床表现，影像学特点，手术治疗及预后情况。方法经磁共振成像（MRI）和计算机体层摄影（CT）及手术证实的胆脂瘤9例，位于脑干腹侧面8例，脑干左侧1例。临床表现早期无症状或不典型，晚期可具有脑干轻微受压表现。全部行手术治疗，其中肿瘤及包膜全切2例，包膜及肿瘤次全切3例，包膜保留内容全切4例。结果4例术后出现化学性脑膜炎，经治疗后痊愈，5例表现为一组或多组脑神经障碍。结论①引起脑干受压的胆脂瘤，其影像学改变与临床表现不同步，影像学反映的病灶大，临床上却不能表现相应的症状。②手术治疗以保留神经功能为主，不必强行剥离肿瘤包膜。

Objective To explort the clinical presentation, radiological features, surgical problems and prognosis of cholesteatoma with brain stem compressed. Method 9 cases of cholesteatoma manifested by MRI and CT, among them, 8 cases located ventral side of brain stem, 1 case in left side of brain stem. clinical presentation in early periods was no or atypical, subtle compressing brain stem in late periods. operation was performed in all cases, 2 cases total removal, 3 cases subtotal resection and 4 cases removed the contents of lesion but remained the capsules. Result Chemical meningitis ocurred in 4 cases and recovered after treatment, cranial nerves disturhances ocurred in 5 cases. Conclusions ① Radiological manifestations is not equivalent with clinical presentation.② The operation should preserve the functions of cranial nerves. There is no need to peel off the capsule of the tumor.