枕下后正中入路治疗枕骨大孔区肿瘤的临床疗效分析

Clinical analysis of the treatment of foramen magnuin tumors with the posterior median approach

目的探讨枕下后正中入路治疗枕骨大孔区肿瘤的临床疗效。方法回顾性分析广东三九脑科医院神经外一科自2012年1月至2019年1月收治的16例采用后正中入路显微外科结合超声吸引切除的枕骨大孔区肿瘤患者的临床资料,其中神经鞘瘤5例,脑膜瘤7例,血管母细胞瘤4例,观察16例患者的术后疗效。结果16例患者中肿瘤全切除14例,次全切除2例。术后出现后组颅神经损伤加重者2例,无手术死亡。随访3个月~7年,除1例术后仍有肢体乏力、行走不稳外,其余患者症状消失。1例次全切除患者术后3年复发。结论枕骨大孔区肿瘤显微手术技巧要求高,脑干、后组颅神经和血管保护十分重要,枕下后正中入路可以广泛地应用于枕骨大孔区肿瘤的手术治疗。

Objective To analyze the clinical effect of suboccipital posterior median approach in the treatment of foramen magnum tumors.Methods Retrospective analysis of 16 cases of tumors in the occipital foramen region from January 2012 to January 2019 were resected by microsurgery combined with cavitron ultrasonic surgical aspirator through posterior median approach.Among them,5 cases were neurofibromas,7 cases were meningiomas,and 4 cases were hemangioblastomas.The curative effect of 16 cases was observed.Results Among the 16 cases,14 cases of forarnen magnum tumors were totally resected and 2 subtotally resected.Posterior cranial nerve injury was aggravated in 2 postoperative cases and no death case was found.The follow-up period was 3 months to 7 years.Except for 1 patient who still had limb weakness and unstable walking after operation,the symptoms of the remaining patients disappeared.One case of subtotal resection relapsed 3 years after the operation.Conclusion The microsurgical resection of foramen magnum tumors requires a high level of surgical skills,and it is very important to protect the brain stem,posterior cranial nerves and vascular during operation.The posterior median approach can be widely used for surgical treatment of tumors in the occipital foramen area.