中颅窝底表皮样囊肿的临床特征和治疗策略（附13例报告）

Clinical features and treatment strategies of middle cranial fossa epidermoid csyts： a report of 13 cases

目的 探讨中颅窝底表皮样囊肿的临床特征和治疗策略,为临床诊治提供依据.方法 回顾性纳入2007年6月至2015年4月兰州大学第二医院神经外科收治的13例中颅窝底表皮样囊肿患者.所有患者均行显微外科手术治疗,分析患者的临床表现、影像学特征、组织病理学特征、手术情况及随访结果.结果 13例患者中,7例全切除,6例近全切除.术后病理检查均为表皮样囊肿.随访时间为7～103个月,平均（40.5±26.1）个月.11例患者MRI检查未见复发,临床症状部分缓解或消失.2例患者MRI检查提示复发并再次手术治疗,其中1例病理检查为炎性增生反应,另1例为复发.结论 中颅窝底表皮样囊肿的临床表现以三叉神经支配区功能障碍为主,影像学表现相对特殊,经硬膜间入路近全切除病变能最大地程度保留神经功能,有效降低传统手术所致的常见并发症发生.

Objective To investigate the clinical features and treatment strategies of middle cranial fossa epidermoid cysts and to provide evidences for their clinical diagnosis and treatment.Methods The clinical data of 13 patients with middle cranial fossa epidermoid cysts,admitted to Neurosurgery Department of Lanzhou University Second Hospital from June 2007 to April 2015,were analyzed retrospectively,which included the clinical presentations,characteristics of imaging and pathology,operations and follow-up results.Results Out of 13 patients,7 patients received complete resection and 6 cases underwent nearcomplete resection.The postoperative pathological examinations indicated epidermoid cysts in all cases.The 13 patients were followed up for 7-103 months （mean：40.5 ±26.1 months）.There was no recurrence in 11 cases base on MR examination whose clinical symptoms were relieved or disappeared.Recurrence was suggested by MR in the remaining 2 cases that underwent a second operation and pathological findings revealed inflammatory granuloma in 1 case and recurrence of epidermoid cyst in the other.Conclusions Common symptoms of middle cranial fossa epidermoid cysts include neurological dysfunctions in areas innervated by the trigeminal nerve,which has characteristic imaging manifestation.Near-complete resection through interdural approach might be helpful for maximal protection of neurological functions and reduction of the complications commonly associated with traditional operations.