联合颞下窝进路颈内动脉重建技术在侧颅底巨大肿瘤切除术中的应用

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors

目的通过总结联合颞下窝进路和颈内动脉重建用于侵犯岩骨段颈内动脉的颅底巨大肿瘤的技术要点和治疗效果,探讨其临床应用价值。方法回顾性分析2015年7月至2017年5月在北京协和医院耳鼻咽喉科因颅底肿物行联合颞下窝进路并重建高位颈内动脉的5例患者的临床资料。其中男2例,女3例;年龄27~55岁。结果5例患者中3例为头颈部副神经节瘤,1例为颈动脉瘤,1例为腺样囊性癌复发;肿物中位横截面积为60 mm×51 mm(范围:28 mm×22 mm~72 mm×58 mm)。所有病例均使用联合颞下窝进路和颈内动脉重建的术式完整切除肿物。术中中位出血量为1000 ml(范围:600~2500 ml)。3例患者术后无暂时或长期脑血管并发症,1例术后出现短暂性脑缺血发作,治疗后好转,1例术后由于脑血管栓塞出现偏瘫。除了复发性腺样囊性癌患者术中切除面神经,其余患者面神经功能均在术后3~12个月内恢复为House-Brackmann分级Ⅰ~Ⅱ级。术后5例患者均规律随访36个月以上,无一例复发。结论对于侵犯高位颈内动脉且无法与动脉分离的侧颅底肿瘤,颞下窝进路联合颈内动脉重建可实现肿瘤的完整切除。

Objective By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach(IFA)and internal carotid artery(ICA)reconstruction for the colossal skull base tumor invading ICA in petrous bone,the clinical application value was discussed.Methods Five patients(2 males,3 females,aging from 27 to 55 years old)who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction,were reviewed.Results Among the five patients,three were paraganglioma of head and neck,one was carotid aneurysms,and one was recurrent adenoid cystic carcinoma(ACC).The median tumor size in the largest cross-section was 60 mm×51 mm(range,28 mm×22 mm-72 mm×58 mm).Complete excision was achieved with IFA and ICA reconstruction.The median blood loss volume was 1000 ml(range,600-2500 ml).Four cases showed no new long-term neurologic sequelae,while one showed hemiplegia due to graft vessel occlusion.Except for the one with ACC having facial nerve cut,others achieved good facial nerve function of HB gradeⅠtoⅡduring 3 to 12 months,follow-up.No tumor recurrence was observed over the median duration of follow-up for above 36 months(range,36-58 months).Conclusion For lesions involved superior part of ICA,which is unable to separate from ICA,IFA and ICA reconstruction can achieve complete excision.