枕骨大孔区肿瘤的显微外科治疗

Microsurgical treatment of foramen magnum tumors

目的 探索枕骨大孔区肿瘤的治疗方法以提高治疗效果。 方法 通过显微外科手术治疗 31例枕骨大孔区肿瘤 ,其中脑膜瘤 13例 ,神经鞘瘤 15例 ,脊索瘤 3例。根据肿瘤附着点、生长方式及手术入路将肿瘤分为 2种类型 :Ⅰ型 :肿瘤主要位于枕骨大孔前方 ,包括基底起源于枕骨大孔上方、前方和前侧方 ,共 15例 ;Ⅱ型 :肿瘤主要位于枕骨大孔后方 ,包括基底起源于枕骨大孔后方、后侧方和椎管内 ,共 16例。采用 3种手术入路切除肿瘤 :枕颈后正中或侧方入路 18例 ,远外侧或经髁入路 10例 ,枕下乙状窦后入路 3例。 结果 肿瘤全切除 2 5例 ,次全切除 5例 ,部分切除 1例 ,无手术死亡。Ⅰ型枕骨大孔区肿瘤全切除 9例 ,次全切除 5例 ,部分切除 1例 ;Ⅱ型均全切除。 结论 Ⅰ型枕骨大孔区肿瘤 ,手术全切除肿瘤困难 ,远外侧经髁入路是切除Ⅰ型枕骨大孔区肿瘤最有效的方法 ;Ⅱ型肿瘤容易全切除 。

Objectives To review the radiological features, and results of microsurgical treatment of foramen magnum tumors. Methods We retrospectively analyzed the results of microsurgical treatment of 31 patients with foramen magnum tumor. Fifteen patients had pathological schwannomas (neurinomas), 13 patients meningiomas, and 3 patients chordomas. According to tumor extension, MRI findings and microsurgical approaches, the tumors were classified in two types. Type Ⅰ tumors located at the ventral foramen magnum,including those originated from the posterior fossa with minimal enlargement of the ventral or anterior lateral (15 patients). Type Ⅱ tumors located at the posterior or lateral foramen magnum,including those arising from the spinal canal with minimal enlargement of the foramen magnum (16 patients). Surgical approaches to tumors in this series included suboccipital posterior approach (18 patients), extreme lateral or transcondylar approach (10), and suboccipital retrosigmoid approach (3). Results Total removal was achieved in 25 patients, subtotal removal in 5, and partial removal in 1. No operative death ocurred. Type Ⅰforamen magnum tumors were totally removed in 9 patients, subtotally removed in 5 and partially removed in 1. All of type Ⅱforamen magnum tumors were totally removed. Conclusions To totally resect type Ⅰforamen magnum tumors, extreme lateral transcondylar approach is an optimal choice. Type Ⅱ foramen magnum tumors can be totally removed with good prognosis.