经迷路下-颈静脉突入路切除颈静脉孔区神经鞘瘤

A Application of sublabyrinth and transjugular process approach for removal of jugular foramen schwannomas

目的回顾经迷路下-颈静脉突入路手术切除颈静脉孔区神经鞘瘤的病例,探讨该入路的临床价值。方法回顾总结2例经迷路下-颈静脉突入路手术切除的颈静脉孔区神经鞘瘤的临床资料,并复习相关文献。结果 2例肿瘤均得到完全切除。术后1例患者出现短暂轻度的后组脑神经损害及面神经不全损害表现(House-BrackmannⅡ级);1例患者原先后组脑神经损害表现改善,无面神经损害表现,听力保留;术后均无脑脊液漏发生。术后随访6个月,2例患者面神经或后组脑神经损害均逐渐恢复或代偿,无肿瘤复发。结论经迷路下-颈静脉突入路操作简便,能在保护迷路的基础上充分暴露颈静脉孔区,适用于主体位于颈静脉孔内并向颅内脑池明显扩展的神经鞘瘤的手术切除。

Objective To explore the clinical value and applicability of the sublabyrinth and transjugular process approach for jugular foramen sehwannomas. Methods Clinical data of two patients with jugular foramen schwannomas which were reseeted via sublabyrinth and transjugular process approach were analyzed retrospectively in combination with review of literatures. Results Total tumor resection was achieved in both cases. After surgery, one patient had short-term impairment of lower cranial nerves and moderate facial nerve paralysis （ House-Brackmann gradel] ）. The other patient had neither facial nerve paralysis nor hearing loss, and the preexisting impairment of lower cranial nerves got improved. No leakage of eerebrospinal fluid occurred after operation. The patients were followed-up for 6 months. All the impairments of cranial nerves were gradually relieved. No tumor recurrence occurred. Conclusion With advantages of ease of operation and good exposure of the jugular foramen region with proper preservation of the labyrinth, the sublabyrinth and transjugular process approach is suitable for resection of schwannomas locating in jugular foramen region with mainly intracranial extension.