桥小脑角区肿瘤相关三叉神经痛的手术治疗

Surgical treatment of trigeminal neuralgia related to cerebellopontine angle tumors

目的探讨显微手术治疗桥小脑角区(cerebellopontine angle,CPA)肿瘤相关三叉神经痛(trigeminal neuralgia,TN)患者的疗效。方法回顾分析我院2011年11月1日~2017年12月31日收治的78例CPA肿瘤相关TN患者临床资料,其中胆脂瘤31例(39.7%),脑膜瘤18例(23.1%),听神经瘤25例(32.1%),三叉神经鞘瘤2例(2.6%),脂肪瘤2例(2.6%)。所有患者均经显微外科手术切除肿瘤,其中26例肿瘤切除后同期行三叉神经微血管减压术(microvascular decompression,MVD)。结果肿瘤全切64例,次全切除10例,部分切除4例;72例患者术后三叉神经痛痊愈,4例患者三神经痛治疗有效,2例无效,随访6~78个月TN症状无复发。1例部分切除脑膜瘤术后3个月MRI复查显示残余肿瘤较前增大,行伽马刀治疗后病灶缩小。结论多种CPA肿瘤可表现为TN症状,枕下乙状窦后入路显微手术是治疗CPA肿瘤相关TN的首选方案;对部分CPA肿瘤相关TN患者的三叉神经既有肿瘤压迫也有三叉神经根部血管压迫切除肿瘤后还需行MVD。

Objective To evaluate the clinical effect of microsurgical treatment of trigeminal neuralgia （TN） related to cerebellopontine angle （CPA） tumors. Methods Clinical data of 78 patients undergoing microsurgical treatment of TN related to CPA tumors between Nov 1, 2011 and Dec 31, 2017 were analyzed retrospectively. The CPA tumors included cholesteatoma （n= 31, 39.7% ）, meningioma （n = 18, 23. 1%）, acoustic neuroma （n = 25, 32. 1% ）, trigeminal neurinoma （ n = 2, 2.6% ） and lipoma （ n = 2, 2.6% ）. All tumors were removed microsurgically. In 26 of them, microvascular decompression （MVD） was performed with Teflon gasket during surgical procedure of tumor removal. Results Total tumor resection was achieved in 64 cases, subtotal resection in 10, and partial resection in 4. The symptom got disappeared in 72 patients and relieved in 4, as well as failed in 2. Postoperative follow-up with duration ranged from 6 to 78 months showed no recurrence. Residual tumor in one patient with partial section of meningioma got enlarged 3 months after operation and lessened after Gamma knife therapy. Conclusion A variety of CPA tumors can resuh in TN. Microsurgical treatment via suboccipital retrosigmoid approach is the preferred alternative for TN related to CPA tumors. After resection of tumor, MVD should be applied to those with both tumor compression and nerve root vascular compression of trigeminal nerve.