巨大海绵窦海绵状血管瘤的硬膜内入路显微外科治疗

Intradural transcavernous surgical mangement of giant cavernous sinus hemangiomas

目的探讨巨大海绵窦海绵状血管瘤(cavernous sinus cavernous hemangiomas,CSHs)的临床特征及显微外科治疗方法,为CSHs的治疗提供临床经验。方法回顾性分析2009年1月—2018年12月解放军东部战区总医院神经外科收治的15例CSHs患者的临床及随访资料;分析患者的临床表现、颅神经受累情况、手术方式、术后并发症及随访结果。结果15例CSHs患者占同期收治的颅内海绵状血管瘤(CHs)患者的5.6%。临床表现为头痛者11例、视神经损害者5例、动眼神经损害者6例、面部感觉异常者2例、肢体无力者1例。15例患者通过扩大翼点、翼点或颞前小切口入路经硬膜内切除血管瘤,均完整切除;无死亡病例。10例患者术后出现同侧Ⅲ、Ⅳ、Ⅴ及Ⅵ神经部分麻痹。术后获得随访的患者9例,随访时间5~117个月,平均48.9个月,均无肿瘤复发表现;其中4例患者遗留长期海绵窦颅神经功能障碍。结论CSHs多具备特征性影像学表现,术前多可明确诊断。经硬膜内入路手术切除是治疗巨大CSHs的有效方法,术中应尽量按界限整块切除,以减少出血。海绵窦内神经功能的保留仍是目前巨大CSHs手术治疗的难点。

Objective To explore the clinical features and microsurgical treatment of giant cavernous sinus cavernous hemangiomas(CSHs).Methods The clinical and follow-up data of 15 patients with CSHs admitted to Department of Neurosurgery,Jinling Hospital,School of Medicine,Nanjing University from January 2009 to December 2018 were analyzed retrospectively.The clinical manifestations,cranial nerve involvement,surgery methods,postoperative complications and follow-up results were analyzed.Results 15 cases of CSHs accounted for 5.6%of intracranial cavernous hemangioma at department of neurosurgery,in the same period.The clinical manifestations were mostly headache in 11 cases,decreased visual acuity in 5,oculomotor nerve damage disfunction in 6,facial numbness in 2 and limb weakness in 1.Intradural resection was performed via the pterion or extended pterion or temporal small arc incision approach.Complete resection was performed in all patients.No death occurred.Ten patients developed partial ipsilateralⅢ,Ⅳ,Ⅴ,andⅥnerve palsy after surgery.9 cases were followed up with mean follow-up time of 48.9 months(5-117 months).None had tumor recurrence,and 4 cases had long-term cavernous sinus cranial nerve dysfunction.Conclusions CSHs has characteristic imaging findings and almost can be definitively diagnosed before operation.Microsurgical total resection via intradural approach is an effective method for the treatment of giant CSHs.En bloc resection should be performed along the border in order to reduce bleeding.The preservation of nerve function in the cavernous sinus is still a difficult point in the surgical treatment of giant CSHs.