颅中、后窝三叉神经鞘瘤的分型及其治疗分析

Classification and surgical treatment of trigeminal schwannomas in middle and posterior fossas(report of 18 cases)

目的探讨颅中、后窝三叉神经鞘瘤的分型、手术方法及其疗效。方法回顾性分析2010~2020年手术治疗的18例颅中、后窝三叉神经鞘瘤的临床资料。按照肿瘤起源的部位分为神经节型(M型)、周围型(V型)、神经根型(P型),并根据肿瘤分型选择相应的手术入路。结果18例中,M型10例(其中M0型1例,Mp型7例,MP型2例),P型8例(其中P0型3例,mP型5例)。12例采用颞下硬膜下经小脑幕入路(7例Mp型,1例M0型,1例P0型,3例mP型),4例采用颞下硬膜外经岩前入路(2例MP型,2例mP),2例使用枕下乙状窦后入路(P0型)。18例中,肿瘤全切除12例(其中M型8例,P型4例),部分切除6例(Mp型2例,P0型2例,mP型2例)。术后症状缓解14例,加重4例。术后随访6个月~8.5年,平均38个月;2例全切除术后复发(M型和P型各1例),4例部分切除进展,其中2例行二次手术,1例选择放疗。结论对于颅中、后窝三叉神经鞘瘤,按照起源部位进行分型利于肿瘤的全切除,降低复发率。建议M型以及部分P型肿瘤使用颞下硬膜下经小脑幕入路,但是肿瘤发生位置多种多样,应具体情况具体分析。

Objective To investigate the classification and surgical outcomes of trigeminal schwannomas in the middle and posterior fossas. Methods The clinical data of 18 patients with trigeminal schwannoma in the middle and posterior fossas who underwent surgery from 2010 to 2020 were retrospectively analyzed. According to the origin of the tumor, the tumors were divided into ganglion type(M type), peripheral type(V type), and nerve root type(P type), and the corresponding surgical approach was selected according to the tumor type. Results Of these 18 patients, 10 patients were classified as M type(1 M0 type, 7 Mp type, and 2 MP type), and 8 as P type(3P0 type and 5 mP type). The subtemporal subdural transtentorial approach was used in 12 patients including 7 Mp type, 3 mP type, 1 M0type and 1 P0 type. The suboccipital retrosigmoid approach was used in 2 patients of P0 type. The subtemporal epidural transpetrosal approach was used in 4 patients including 2 MP type and 2 mP type. Total tumor resection was achieved in 12 patients including 8 M type and 4 P type, and partial resection in 6 patient including 2 Mp type, 2 P0 type and 2 mP type. Symptoms were relieved in 14patients and aggravated in 4. The postoperative follow-up(range, 6 months to 8.5 years;average, 38 months) showed recurrence in 2patients with total tumor resection(1 M type and 1 P type), and progression in 4 patients with partial tumor resection, of whom 2 patients underwent secondary surgery and 1 received radiotherapy. Conclusions For the trigeminal schwannomas in middle and posterior fossas,the classification according to the tumor origin is beneficial to the total tumor resection and reduce in the recurrence rate. It is recommended to use the subtemporal subdural transtentorial approach for M-type and P-type tumors, but the location of the tumor is varied and the surgical methods should be selected individually.