多学科协作手术治疗颈静脉孔区颅内外沟通型肿瘤的临床分析

Clinical analysis on multidisciplinary surgical treatment for intracranial and extracranial communicating tumors in jugular foramen area

目的总结分析多学科协作手术切除颈静脉孔区哑铃型肿瘤的临床疗效。方法回顾性分析2011年4月—2023年7月重庆医科大学附属第一医院神经外科后颅底脑干组收治的5例多学科协作手术治疗的颈静脉孔区颅内外沟通型肿瘤患者的临床资料。采集信息包括一般情况、临床表现、专科检查、辅助检查、手术方法、术后并发症、病理及随访结果。结果所有病例均由神经外科、耳鼻咽喉科、颌面外科行MDT讨论并采用MDT手术治疗方案,其中2例行颞下窝Fisch A型联合颈部入路,3例行颅颈联合入路。5例患者中次全切除4例,部分切除1例。术后病理结果提示脑膜瘤2例,神经鞘瘤1例,副神经节瘤1例,脊索瘤1例。术后后组颅神经损伤3例,面瘫3例,听力下降2例,脑脊液漏2例,颅内感染3例。平均随访时间51.8个月(8~150个月);平均随访卡氏功能状态评分(KPS)90分(80~100分)。结论多学科协作手术不仅增加了颈静脉孔区哑铃型肿瘤的切除程度,而且提高了颈静脉孔区哑铃型肿瘤的手术安全性。当全切除较为困难或可能导致较为严重的并发症时,次全切除后辅助放疗也是一种较好的治疗方案。

Objective To summarize and analyze the clinical efficacy of multidisciplinary surgery for the treatment of dumbbell-shaped jugular foramen tumors.Methods The clinical data of 5 patients with dumbbell-shaped jugular foramen tumors treated with multidisciplinary surgery at the Posterior Skull Base Brainstem Group of the Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University from April 2011 to July 2023 were analyzed retrospectively.The general conditions,clinical manifestations,specialist examinations,auxiliary examinations,surgical methods,postoperative complications,pathology and follow-up results were extracted.Results All cases were discussed and treated in multidisciplinary treatment(MDT)by neurosurgery,otolaryngology,and maxillofacial surgery.Fisch A type combined cervical approach was performed in 2 cases,and combined craniocervical approach was performed in 3 cases.Four patients(4/5)achieved subtotal resection and one partial resection.Postoperative pathological results showed 2 cases of meningiomas,1 of schwannoma,1 of paraganglioma and 1 of chordoma.After surgery,3 patients presented low cranial nerves palsies,3 with facial palsies,2 with hearing loss.There were also 2 cases of cerebrospinal fluid leakage,and 3 cases of intracranial infection.The average follow-up time was 51.8 months(8-150 months).The average follow-up Karnofsky performance scale was 90 points(80-100 points).Conclusions Multidisciplinary surgery not only increases the degree of resection of dumbbell-shaped jugular foramen tumors but also improves the surgical safety.When total resection is difficult or may lead to serious complications,subtotal resection with adjuvant radiotherapy may be a better treatment option.