三叉神经痛型桥小脑角胆脂瘤的回顾性研究

Cholesteatoma of the cerebellopontine angle presented as trigeminal neuralgia

目的 探讨三叉神经痛型桥小脑角胆脂瘤的有效诊断和治疗方法 ,减少手术并发症的发生。方法 采用回顾性研究 ,总结 1990～ 2 0 0 0年天津医科大学第三医院和上海公利医院 13例患者的临床资料。结果 13例患者中 ,头颅CT检查仅 1例报告桥小脑角及鞍上池胆脂瘤 ;听性脑干反应(auditorybrainstemresponse ,ABR)检查 1例波Ⅴ潜伏期及Ⅰ Ⅴ波间期延长 ;眼震电图检查 9例异常 (2例麻痹 ,7例减弱 )。限于设备条件均未作磁共振成像检查。术中可见胆脂瘤组织或其囊膜包绕三叉神经根部。患者均经乙状窦后进路切除胆脂瘤而未行三叉神经感觉根部分切断术 ,10例随访 2年以上 ,3例随访未达半年 ,均获临床痊愈。 1例胆脂瘤延伸到小脑幕上 ,经乙状窦后进路同时取出幕上胆脂瘤。结论 眼震电图在本病表现异常的机率高于CT及ABR ,乙状窦后进路是首选的手术路径 ,胆脂瘤完全切除不必加行三叉神经感觉根部分切断术。

Objective To explore the effective methods of diagnosis and treatment for cholesteatoma of the cerebellopontine angle presented as trigeminal neuralgia.Methods The Clinical data of 13 patients were studied retrospectively. Results Only 1 case of Cholesteatoma in cerebellopontine and suprasellar cistern was detected with cranial CT scans among 13 patients. Prolonged latency of Wave V and interpeak peak latencies of I-V Wave were recorded in 1 case on auditory brainstem response(ABR). But 9 patients had abnormality in ENG (2 paralysis, 2 paresis). During the operations, we found that cholesteatoma tissue or its capsule wrapped the roots of trigeminal nerves. The cholesteatoma were removed through post-sigmoid sinus approach without partial amputation of trigeminal posterior root. All the patients were clinically cured by extraction of cholesteatoma with following up period of 3 years (10 cases) and half of a year(3 cases). Cholesteatoma extended above tentorium was completely resected with post-sigmoid sinus approach in one case. Conclusions ENG is more sensitive than cranial CT and ABR for diagnosis of cholesteatoma in the cerebellopontine angle. The post-sigmoid sinus approach is the best operative approach. It is unnecessary to have the partial amputation of trigeminal posterior root if cholesteatoma can be completely removed. When cholesteatoma extends above tentorium, it can be removed simultaneously by post-sigmoid sinus approach.