颈静脉孔区肿瘤的影像学特征分析

Clinical and imaging features of jugular foramen tumors

目的探讨颈静脉孔区肿瘤的影像学特征,对颈静脉孔区常见肿瘤进行鉴别诊断,指导外科手术治疗。方法回顾性分析中南大学湘雅医院神经外科1998年4月~2011年5月38例颈静脉孔区肿瘤的影像学资料。结果 38例颈静脉孔区肿瘤中神经鞘瘤25例,颈静脉球瘤8例,脑膜瘤5例,38例均行颅底CT、MRI平扫增强检查及显微手术治疗。主要首发症状有耳鸣、听力下降、头痛、行走不稳、吞咽困难、声音嘶哑等。颈静脉球瘤呈典型的＂盐椒征＂、强化明显,颈静脉孔扩大、边缘极不规则;神经鞘瘤常呈不均匀强化、部分囊性变,颈静脉孔扩大、边缘规则;脑膜瘤＂脑膜尾征＂典型,颈静脉孔扩大不明显、边缘骨质增生硬化较不规则、偶可见钙化。结论颈静脉孔区不同类型肿瘤有其特有的影像学特征,影像学检查可清晰显示肿瘤与相邻结构改变,有利于神经外科医生制定合适的治疗策略。

Objective To study the clinical and imaging features of jugular foramen tumors,so as to differentiate the tumors of this area and to guide the surgical treatment. Methods Clinical and imaging data of 38 cases suffering from jugular foramen tumors surgically treated in our department from April 1998 to May 2011 were analyzed retrospectively. Results The tumors of jugular foramen included schwannoma（ n = 25）,glomus jugulare tumor（ n = 8） and meningioma（ n = 5）. All cases received skull base CT and MRI examinations before microsurgical treatment. Their initial symptoms mainly included tinnitus,hearing loss,headaches,unsteady gait,dysphagia and hoarseness. As for the imaging features,glomus jugulare tumor showed typical ＂salt pepper sign＂with obvious enhancement,enlargement and irregular edge of jugular foramen,Schwannoma often had heterogeneous enhancement and part of cystic degeneration with regular edge of the foramen,meningioma had typical＂dural tail sign＂without obvious expansion of the foramen but with irregular bone hyperostosis,even calcification. Conclusion The imaging features of different types of jugular foramen tumors are significantly different. Imaging can clearly show the tumor and the adjacent structural changes,which can help neurosurgeons to develop appropriate treatment strategies.