显微手术治疗25例延颈交界区肿瘤

Microsurgery treatment of 25 tumors in medullocervical junction

目的 观察显微手术治疗延颈交界区肿瘤的临床效果.方法 回顾性分析25例应用显微外科手术治疗的延颈交界区肿瘤患者的资料.术前17例行CT血管造影（CTA）检查.4例应用Onyx胶行肿瘤供血动脉栓塞术,栓塞后1周内行开颅手术.14例经后正中入路手术,11例经远外侧入路手术.结果 25例中,肿瘤全切除21例（84％）,次全切除4例（16％）,无死亡病例.术后发生肺部感染3例（12％）;切口漏2例（8％）.2例术中磨除1/3 ～ 1/2枕髁,术后颈托固定3个月.1例术前行枕动脉栓塞的患者出现枕部直径约3 cm头皮坏死,经积极治疗后好转.23例获得6～ 48个月随访,失访2例.随访期内无死亡病例,19例全切除患者均无复发,4例次全切患者2例复发.19例Karnofsky功能状态评分≥80分,5例有不同程度的后组脑神经症状,2例能生活自理.术前行供血动脉栓塞的4例患者,术中肿瘤均全切除,随访期内Kamofsky评分均＞80分.结论 术前CTA检查及经DSA行供血动脉栓塞术、选择恰当的手术入路及术中沿蛛网膜平面操作,是手术成功的关键.

Objective To observe the clinical effects of microsurgical treatment for tumors in the medullocervical junction.Methods The clinical data of 25 patients with tumors in the medullocervical junction were analyzed retrospectively.CTA was examined in 17 cases.The feeding arteries were embolized by Onyx glue in 4 patients and the microsurgical procedures were performed after 1 week.The suboccipital midline approach was chosen in 14 cases and the far lateral approach in 11.Results Complete tumor resection was achieved in 21 patients （84%）,subtotal tumor resection was done in 4 patients （16%） and no case was dead.There were pulmonary infection in 3 cases （12%）,leakage of incision in 2 （8%）,neck collar fixed for 3 months in 2 cases because of getting ride of 1/3-1/2 occipital condyle during operation,diameter of about 3 cm occipital scalp necrosis in one after operation.The preoperative occipital artery embolism patient became better in occipital scalp necrosis after active treatment.23 patients were followed-up for 6 to 48 months,and 2 patients were not followed-up.There was no recurrence in 19 cases after complete tumor resection.2 tumors recurrence were found in 4-cases after subtotal tunor resection.There was no dead case during follow-up.The Karnofsky performance scale was above 80 in 19 patients.5 patients experienced different degrees of cranial nerve dysfunction symptoms,2 patients lived independently.4 tumors with preoperative occipital artery embolism were completely removed and the Karnofsky performance scales were above 80 during the follow-up period.Conclusions Doing preoperative examinations of CTA,embolizing feeding arteries through DSA,choosing proper operation approach and operating along subarachnoid flat were important for successful resection of tumors in the medullocervical junction.