三叉神经鞘瘤的诊断与手术入路选择

Diagnosis and operative approaches of trigeminal neurilemmoma

目的 探讨三叉神经鞘瘤的诊断与手术入路选择。方法 回顾性分析28例三叉神经鞘瘤的临床资料。结果 肿瘤获全切除25例,次全切除2例和大部切除1例。出院时好转27例,加重1例。结论 三叉神经鞘瘤可分成为:①颅中窝型;②颅后窝型;③颅中后窝型;④颅外型;⑤颅中窝颅内外沟通型;⑥颅中后窝颅内外沟通型。颅中窝型肿瘤宜取翼点或改良翼点入路;颅后窝型肿瘤宜取枕下乙状窦后入路;颅中后窝型肿瘤宜取颞底经天幕入路;颅中窝颅内外沟通瘤宜取颞下硬脑膜外入路。

Objective To evaluate the diagnosis and operative approaches of trigeminal neurilemmomas. Methods The clinical data of 28 consecutive patients with trigeminal neurilemmomas were retrospectively analyzed. Results Total tumor removal was achieved in 25 patients, subtotal in 2 and largely partial in 1.0n discharge, nervous system status was improved in 27 and aggravated in 1. Conclusion Trigeminal neurilemmomas can be classified into six types;(1)middle fossa tumor;(2)posterior fossa tumor;(3)middle and posterior fossa tumor; (4)extracranial space tumor; (5)middle fossa and extracranial space tumor;(6)middle and posterior fossa and extracranial space tumor. It is optimal to remove the middle fossa tumor via pterion approach or modified pterion approach, the posterior fossa tumor via suboccipital retrosigmoid approach, the middle and posterior fossa tumor via subtemporal transtentorial approach, middle fossa and extracranial space tumor via subtemporal-transzygomatic epidural approach.