颈静脉球瘤10例诊疗分析

Diagnosis and therapy of glomus jugulare tumor in 10 cases

目的分析探讨颈静脉球瘤临床特点,总结手术疗效,提高该病诊治经验。方法回顾性分析10例经数字减影血管造影和/或术后病理证实的颈静脉球瘤患者的临床资料,总结该病的临床特征、影像学特点、围手术期处理、手术方式及随访效果。结果所有患者均为单耳发病,其中男2例,女8例。表现为单侧搏动性耳鸣6例,听力下降8例,耳痛及眩晕3例,耳流脓性或脓血性分泌物4例,因体检发现耳道肿物就诊1例。6例因肿物突入外耳道,鼓膜不能窥及,4例可透过鼓膜看见鼓室内红色搏动,鼓膜稍向外膨隆。纯音测听示传导性聋4例,混合性聋5例,感音神经性聋1例。所有患者均行颞骨CT及MRI检查,鼓室球瘤可见鼓室、外耳道内充填不规则软组织密度影;颈静脉球体瘤可见颈静脉孔区软组织密度影,周围呈“蚕蚀样”骨质破坏,肿物突向鼓室及外耳道,增强扫描可见明显强化。3例颈静脉球体瘤行DSA检查可见颈静脉孔区浓密肿瘤染色,2例由咽升动脉供血,1例由咽升动脉和枕动脉供血。6例鼓室球瘤患者均行耳道乳突径路鼓室球瘤切除术,3例颈静脉球体瘤患者行颞下窝A型径路颈静脉球体瘤切除术,1例颈静脉球体瘤患者行伽玛刀治疗。所有病例随访10个月至5.5年,均无复发,未出现影响生活的严重并发症。结论颈静脉球瘤有特征性的临床表现,以单侧搏动性耳鸣和不同程度的听力下降最为多见,结合仔细的专科查体和完善的影响学检查不难诊断。鼓室球瘤患者通过中耳显微手术能达到良好疗效,颈静脉球体瘤患者因解剖位置特殊,对术者及围手术期的规范化处理要求较高,并且要求诊疗团队具有侧颅底外科手术的知识及经验,否则容易引起严重并发症。

Objective To analyze and explore the clinical characteristics of glomus jugunlare tumor,summarize the surgery effect,and improve the experience of diagnosis and treatment of the disease.Methods It was retrospectively analyzed for the clinical data of 10 patients with glomus jugulare tumor confirmed by digital subtraction angiography(DSA)and/or postoperative pathology.The clinical features,imaging features,perioperative management,surgical methods and follow-up results of the disease were summarized.Results All the cases were single ear involvement,including 8 females and 2 males.There were 6 cases of unilateral pulsatile tinnitus,8 cases of hearing loss,3 cases of earache and dizziness,4 cases of discharge from the ear canal.And a case of ear canal mass was found by physical examination.In 6 cases,the tympanic membrane could not be seen due to the tumor protruding into the ear canal.In 4 cases,cherry red or dark red pulsation in the tympanic cavity could be seen through the tympanic membrane,and the tympanic membrane was slightly bulging outward.Pure tone audiometry showed conductive hearing loss in 4 cases,mixed hearing loss in 5 cases,and sensorineural hearing loss in 1 case.CT and MRI of temporal bone were performed in all cases.Tympanic body tumor showed the density of irregular soft tissue in the tympanum and external auditory canal;Glomus jugulare paraganlioma showed the density of soft tissue in the jugular foramen area,and the surrounding area showed“corroded”bone destruction and mass protruding to the tympanum and external auditory canal.The enhanced scan shows obvious enhancement.3 cases of glomus jugulare paraganlioma underwent DSA examination and showed dense tumor staining in the jugular foramen area.2 cases were supplied by the ascending pharyngeal artery,and 1 case was supplied by the ascending pharyngeal artery and occipital artery.All 6 patients with tympanic body tumor underwent retroauricular incision tumor resection,3 patients with glomus jugulare paraganlioma underwent infratemporal fossa type A approach tumor resection,and 1 patient underwent gamma knife treatment.All cases followed up for 6 months to 5.5 years were no recurrence or serious complications affecting life.Conclusion Glomus jugulare tumors have their characteristic clinical features,most of which are unilateral pulsing tinnitus and different degrees of hearing loss.It is not difficult to diagnose with careful physical examination and image inspection.Patients with tympanic body tumor can achieve good results through middle ear surgery.Patients with glomus jugulare paraganlioma have high requirements for the surgeon and perioperative treatment due to their special anatomical position.The team is required to have knowledge and experience in lateral skull base surgery.Otherwise,it may easily lead to serious complications.