颈内动脉支架在颅底手术中的应用

Application of internal carotid artery stent in skull base surgery

目的总结颅底手术中颈内动脉支架的应用经验,明确颈内动脉支架在颅底手术中的重要作用。方法回顾性分析2019年7月至2021年1月上海交通大学附属第六人民医院耳鼻咽喉头颈外科诊治的22例置入颈内动脉支架的颅底肿瘤患者的临床资料。其中男性17例,女性5例;左侧5例,右侧16例,双侧1例;年龄33~75岁;颈静脉球副神经节瘤4例,颈静脉孔区软骨肉瘤1例,颈动脉体副神经节瘤1例,鼻咽癌放疗后16例。结果22例患者术前根据CT血管造影(CTA)、MRI以及数字剪影血管造影(DSA)图像评估颈内动脉受侵蚀程度,发现所有患者的颈内动脉均有不同程度受累,遂于术前置入颈内动脉支架。术中发现肿瘤组织不同程度地包绕颈内动脉,所有患者的肿瘤均全切或次全切除,且无术中及术后并发症发生。术后随访5个月~2年,所有患者均未出现自发性出血、假性动脉瘤等并发症,所有病例均未出现颈内动脉支架段狭窄或闭塞。结论对于颅底肿瘤患者,术前影像学提示颈内动脉受累节段局限,术前放置颈内动脉支架是一种安全有效的治疗方法。

Objective To report the experience of the application of internal carotid artery stent in skull base surgery,and to clarify the important role of internal carotid artery stent in skull base surgery.Methods A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People′s Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted.Among them,17 were male and 5 were female,aged between 33 and 75 years.There were 5 cases on the left,16 cases on the right,and 1 case on both sides.Of these,there were 4 cases of jugular paraganglioma,1 case of chondrosarcoma in the jugular foramen,1 case of carotid body paraganglioma,and 16 cases of nasopharyngeal carcinoma after radiotherapy.Results The degree of internal carotid artery erosion was assessed by computed tomography angiography(CTA),magnetic resonance imaging and digital subtraction angiography(DSA)images in 22 patients before surgery.It was found that the internal carotid artery was involved to varying degrees in all patients,so internal carotid artery stents were implanted before surgery.Tumor tissue was found to surround the internal carotid artery to varying degrees.Total or subtotal tumor resection was performed in all patients,and no intraoperative and postoperative complications occurred.The postoperative follow-up was 5 months to 2 years,and all patients had no complications such as spontaneous bleeding and pseudo aneurysm.There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases.Conclusions For patients with skull base tumors,preoperative imaging indicates the limited involvement of the internal carotid artery,and internal carotid artery stent implantation before surgery is a safe and effective treatment.