髁旁-颈外侧入路切除颈静脉孔神经鞘瘤15例疗效分析

Paracondylar-laterai cervical approach for resection of jugular foramen schwannomas： a retrospective analysis of 15 cases

目的 探讨髁旁-颈外侧入路切除颈静脉孔神经鞘瘤的临床效果.方法 回顾性分析2011年11月至2016年3月中南大学湘雅医学院神经外科收治的15例采用髁旁-颈外侧入路一期切除颈静脉孔神经鞘瘤的患者资料,男性7例,女性8例,年龄22～77岁,平均（41.9±15.8）岁.12例为首次手术,3例为再次手术.临床表现和体征包括：耳鸣、听力下降10例;吞咽、饮水困难8例;声音嘶哑9例;伸舌偏向病灶侧7例;闭目难立及共济失调等小脑体征8例;病灶对侧肌力减退1例;面部麻木或疼痛2例;面神经功能为2级者1例.根据颈静脉孔神经鞘瘤分型：B型2例,C型4例,D型9例.通过门诊或电话随访,术后3、9、12个月复查颅底MRI,观察肿瘤有无复发和颅神经功能变化情况.结果 14例患者肿瘤全部切除,1例次全切除.术后新发吞咽困难2例,吞咽困难较术前加重3例;新发声嘶2例;面瘫加重1例;颅内感染2例,肺部感染2例,皮下积液1例,脑脊液鼻漏1例,术后5例留置胃管.无围手术期死亡、颅内出血和听力下降病例.随访时间3 ～ 33个月,平均（26.9±11.2）个月.2例吞咽功能较术前改善,3例声音嘶哑较术前减轻,3例伸舌偏斜改善,9例听力改善和（或）耳鸣消失,1例面神经功能恢复正常,7例平衡功能较术前改善.2例术前面部麻木或疼痛患者、1例肌力下降患者神经功能均恢复至正常.随访结束时无肿瘤复发及进展病例.结论 髁旁-颈外侧入路是切除颅内外沟通颈静脉孔神经鞘瘤的一种入路选择.

Objective To explore the effects of paracondylar-lateral cervical approach for resection of the jugular foramen schwannoma （JFS）.Methods A total of 15 patients with JFS operated via the paracondylar-lateral cervical approach between December 2011 and March 2016 at Department of Neurosurgery in Xiangya Hospital of Central South University were retrospectively analyzed.There were 7 males and 8 females,aging from 22 to 77 years with a mean age of （41.9 ± 15.8） years.There were 12 patients who accepted primary surgery,3 patients who accepted secondary surgery.There were 10 patients with tinnitus or hearing loss,8 patients with dysphagia,9 patients with hoarseness,7 patients with tongue hemiparesis,8 patients with ataxia,1 patient with Pyramidal signs,2 patients with facial hypesthesia or pain,1 patient with facial paresis.According to Samii JFS grading system,2 patients were type B,4 were type C and 9 were type D.All patients were followed-up through outpatient and telephone by MRI in 3,9,12 months postoperation.Results Gross total removal of tumors were achieved in 14 patients and subtotal removal in 1 patient.Two patients had new hoarseness,2 had new dysphagia and 3 had more serious dysphagia,1 patient had more serious facial paresis after the operation.There were 2 patients with intracranial infection,2 with pneumonia,1 with subcutaneous effusion,1 with cerebrospinal fluid rhinorrhea,5 with gastric intubation during perioperative period.There were no death,intracranial hematoma and decreased hearing patients.All patients were followed up,the follow-up time were 3 to 33 months with a mean of （26.9 ± 1 1.2） months.Till to the latest follow up,dysphagia improved in 2 cases,hoarseness and tongue hemiparesis improved in 3 cases,hearing loss and tinnitus improved in 9 cases,balance function improved in 7 cases,facial hypesthesia and pain improved in 2 cases,pyramidal signs disappeared in 1 case,facial nerve function improved to normal in 1 case.There was no recurrence and progressed case.Conclusion Paracondylar-lateral cervical approach is an alternative approach for both intracranial and extracranial JFS.