显微外科治疗枕骨大孔区肿瘤58例

Microsurgical treatment of tumours in foramen magnum： 58 cases report

目的回颐性分析枕骨大孔区肿瘤的临床特点，探讨其最佳诊疗方法。方法对收治的58例枕骨大孔区肿瘤患者的临床资料进行回顾性分析，患者均采用显微外科手术治疗，后期21例患者常规采用术中神经电生理监测。结果58例患者肿瘤全切除48例（82．8％）；10例包绕柞动脉型全切除5例（50．0％），48例未包绕椎动脉型全切除43例（89．6％）；硬脑膜内型47例全切除43例（91．5％），硬啮膜内、外沟通型9例全切除3例（33．3％），2例硬脑膜外型全切除；50例患者症状明显好转，3例症状无改变，5例症状恶化；后期21例行术中神经电生理监测的患者术后症状均明显改善，治疗效果明显优于未监测病例组；58例患者手术死亡3例。50例患者完成术后随访6个月～3年，远期生活质量KPS评分在80～100分44例，小于或等于80分者6例。结论枕骨大孔区肿瘤的显微手术治疗效果较好，合适的手术入路及精细的显微操作技术对肿瘤的切除十分重要。硬脑膜内、外沟通型肿瘤和包绕椎动脉型肿瘤手术全切难度大，风险高，术前应仔细评估。术中神经电生理监测技术的应用和术后并发症的及时处理可明显提高预后。

Objective To explore the optimal diagnosis and treatment strategy of tumors at the foramen magnum, the clinical characteristics were analyzed retrospectively. Methods The clinical data of 58 cases with foramen magnum tumors treated with microsurgery in our department were collected and analyzed retrospectively. And intraoperative neurophysiological monitoring was employed in later 21 cases. Results Gross total resection was achieved in 48 of the 58 cases; Five of the 10 patients with VA encased by tumors were totally resected. Full resection was achieved in 43 of the last 48 cases. Forty-three of the 47 cases with intradural tumors got complete resection, and total resection was achieved in 3 and 2, respectively, in 9 intra-extradural communicated tumors and 2 extradural ones. Symptoms were significantly improved in 50 cases, worsened in 5 patients, and maintained stable in the last 3 patients. Post-operative symptoms were obviously improved in the later 21 cases with intraoperative neurophysiological monitoring employed and the therapeutic effect of the treatment was much better than the former cases. Three patients died postoperatively. Fifty cases got complete follow-up from 6 months to 3 years. Among them, forty-four patients had a KPS score of 80-100, but the other 6 patients less than 80. Conclusion Microsurgical treatment for foramen magnum tumors is effective. Optimal surgical approaches and precise micro-operative techniques are crucial for the tumor removing. It is quite difficult and risky to fully resect the intraextradural communicated tumors and the ones encasing vertebral artery. Preoperative evaluation should be profound. The application of intra-operative electrophysiological monitoring and the timely management of post-operative complications can improve the prognosis obviously.