颈静脉孔区神经鞘瘤的手术治疗

Surgical treatment for jugular foramen schwannomas

目的探讨外科手术治疗颈静脉孔区神经鞘瘤(jugular foramen schwannomas,JFS)的入路选择及术中神经保护技巧。方法回顾性分析22例颈静脉孔区神经鞘瘤病人的临床资料。根据颈静脉孔区神经鞘瘤分型,6例A型肿瘤采用枕下乙状窦后入路,2例B型肿瘤采取枕下经颈静脉突入路,1例C型肿瘤采用颈侧入路,4例C型和9例D型肿瘤采取髁旁-颈外侧入路。结果肿瘤全切除20例,次全切除2例。术后新发吞咽困难2例,吞咽困难较术前加重5例;术后新发声音嘶哑3例,声音嘶哑较前加重1例;新发舌肌萎缩、伸舌偏斜1例;面瘫加重2例;无新发面瘫及听力下降、颅内出血、围手术期死亡病例。随访3～48个月,耳鸣、听力下降较术前改善12例,吞咽功能、声音嘶哑较术前改善各7例,面神经功能恢复正常3例。无肿瘤复发、进展及死亡病例。结论根据颈静脉孔区神经鞘瘤的累及范围,应用微创理念精确磨除骨质,选择恰当的手术入路到达病变区域,可以在全切除肿瘤的同时减少创伤,保护脑神经。

Objective To investigate the surgical approach and neuroprotective techniques in the surgical treatment of jugular foramen schwannomas（JFS）. Method Clinical data of 22 patients with JFS were analyzed retrospectively. Based on the grading scale of JFS,the suboccipital retrosigmoid approach was used to resect type A tumors in 6 patients, the suboccipital transjugular process approach was used to resect type B tumors in 2 patients, the lateral-cervical approach was used to resect type C tumor in 1 patient and paracondylar-lateral cervical approach was used to resect type C tumors in 4 patients and type D tumors in 9 patients. Results Total tumor removal was achieved in 20 patients and subtotal resection in 2. The newly dysphagia occurred in 2 patients and dysphagia grew worse in 5 after surgery. The newly hoarseness occurred in 3 patients and hoarseness grew worse in 1. The newly tongue muscle atrophy and deflection occurred in 1 patient and facial paralysis grew worse in 2. No newly facial palsy, hearing loss, intracranial hematoma and perioperative death were found. The patients were followed up for 3 to 48 months, tinnitus and hearing loss were improved in 12 patients, both of dysphagia and hoarseness were improved in 7, facial nerve function recovered to normal in 3. There was no recurrent, progressed and dead patients. Conclusions According to the extent involved by JFS, the bones are resected precisely and the proper approach was chosen to lesion area by using minimal invasive concept, the tumor could be resected completely with reduction of injury and protection of the cranial nerve.