多学科协作、多技术融合手术治疗颈静脉孔区肿瘤

Multidisciplinary teams and multiple techniques in surgical management of jugular foramen tumors

目的回顾颈静脉孔区肿瘤的手术治疗效果,探讨多学科协作、多技术融合手术在颈静脉孔区肿瘤治疗中的价值。方法纳入重庆医科大学附属第一医院神经外科自2011年1月至2020年7月行颈静脉孔区肿瘤切除术患者19例,根据Samii分型,其中A型7例,B型5例,C型0例,D型7例;显微神经外科手术治疗14例,显微镜+神经内镜双镜联合手术治疗2例,多学科协作手术治疗3例;手术入路采用枕下乙状窦后入路5例,基础远外侧入路7例,远外侧经髁-髁上入路4例,颞下窝A型入路1例,远外侧-迷路后入路2例。所有患者术后根据肿瘤性质、残留与否及残留程度选择性行辅助放射治疗。分析所有患者肿瘤切除程度、肿瘤复发情况、手术相关并发症、神经功能预后等情况。结果手术次全切率及以上达84.2%;1例患者失访,18例随访患者中1例术后1年肿瘤复发,于外院再次行手术治疗,其余患者末次随访期内无肿瘤复发,复发率为5.6%;所有患者末次随访期内无手术相关死亡,术后2例患者出现枕部皮下积液(10.5%)。手术相关神经功能障碍以Ⅸ~Ⅹ颅神经最常见为52.6%(10/19),其次为Ⅶ颅神经47.4%(9/19)、Ⅷ颅神经36.8%(7/19)、Ⅻ颅神经10.5%(2/19)。手术相关暂时性神经功能障碍:Ⅶ颅神经77.8%(7/9)、Ⅷ颅神经50.0%(3/6)、Ⅸ~Ⅹ颅神经33.3%(3/9)、Ⅻ颅神经0(0/2)。末次随访期内术后Ⅶ、Ⅷ、Ⅸ~Ⅹ、Ⅺ、Ⅻ颅神经功能保留及改善率分别为88.2%(15/17)、82.4%(14/17)、64.7%(11/17)、100%(17/17)、88.2%(15/17)。结论神经功能的保留及改善应作为颈静脉孔区肿瘤手术治疗的首要目标,手术后颅神经功能障碍者应尽早行康复治疗;多学科协作、多技术融合于颈静脉孔区肿瘤个体化治疗中具有重要价值;辅助放射治疗可用于颈静脉孔区肿瘤切除术后残余肿瘤复发的控制。

Objective To analyze the curative effect of Jugular foramen tumors explore the value of multidisciplinary teams and multiple techniques in surgical management of jugular foramen tumors.Methods Nineteen patients with jugular foramen tumors accepted surgery from January 2011 to July 2020 in neurosurgery department of the First Affiliated Hospital of Chongqing Medical University.According to the classifications of Samii,they were divided into A type 4 cases,B type 5 cases,C type 0 and D type 7 cases.Fourteen patients underwent micro neurosurgery,another 2 and 3 patients accepted microscopic combined with endoscopic surgery respectively.The surgical approaches included infraoccipital retrosigmoid approach in 5 cases,basic far lateral approach in 7 cases,far lateral transcondylar supracondylar approach in 4 cases,fisch A infratemporal fossa approach in 1 case,and far lateral retrolabyrinthine approach in 2 cases.All patients were treated with adjuvant radiotherapy according to the pathological result and extent of residual tumor.The degree of tumor resection,tumo recurrence,surgical associated complications and preservation of cranial nerve function were analyzed.Results The tumor resection rate of subtotal resection and above was 84.2%.One patient was lost to follow-up,and one of the 18 follow-up patients had tumor recurrence one year after operation,and they were operated again in other hospitals.In the remaining follow-up patients,there was no tumor recurrence in the last follow-up period,and the recurrence rate was 5.6%;there was no operation-related death in all patients during the last follow-up period,and 2 patients had occipital subcutaneous effusion(10.5%).Surgical related neurological dysfunction was the most common inⅨ-Ⅹcranial nerve(52.6%,10/19),followed byⅦcranial nerve(47.4%,9/19),Ⅷcranial nerve(36.8%,7/19)andⅫcranial nerve(10.5%,2/19).Surgical related temporary neurological dysfunction:77.8%(7/9)ofⅦcranial nerve,50.0%(3/6)ofⅧcranial nerve,33.3%(3/9)ofⅨ-Ⅹcranial nerve and 0(0/2)ofⅫcranial nerve.During the last follow-up period,the rates of preservation and improvement of cranial nerve function inⅦ,Ⅷ,Ⅸ-Ⅹ,ⅪandⅫwere 88.2%(15/17),82.4%(14/17),64.7%(11/17),100%(17/17)and 88.2%(15/17),respectively.Conclusion The preservation and improvement of cranial nerves function should be prior goal of surgery.Multidisciplinary teams and multiple techniques have great value on individual surgical treatment of jugular foramen tumors.Adjuvant radiotherapy could be applied to control the recurrence of residual tumor after surgery.