三叉神经鞘瘤的诊断与手术治疗

Diagnosis and surgical treatment of trigeminal neurinoma

目的 报告位于中颅窝及中、后颅窝三叉神经鞘瘤的诊断与手术治疗的经验。方法 回顾性分析13例中颅窝及中、后颅窝三叉神经鞘瘤的临床及影像学特征、手术方式及疗效。结果 三叉神经鞘瘤病人的临床表现以患侧三叉神经症状及体症为主 ,常同时伴有Ⅲ、Ⅳ、Ⅵ、Ⅶ对脑神经症状 ,CT和MRI对临床诊断及病变累及范围有重要意义。本组三叉神经鞘瘤仅位于中颅窝者 5例 ,同时长入后颅窝者 8例。采用额颞硬膜外入路全切肿瘤 11例 ,次全切除 2例。术后 10例脑神经症状得到改善 ,2例脑神经症状无变化 ,1例脑神经症状加重 ,无新的脑神经症状出现 ,无残疾及死亡病例。随访 10例 ,时间 6～ 36个月 ,无肿瘤复发。结论 MRI检查可提高三叉神经鞘瘤的诊断率。运用额颞硬膜外入路显微手术切除中颅窝及中、后颅窝三叉神经鞘瘤能提高治疗效果。

ObjectiveTo report the experience of diagnosis and microsurgical treatment of patients with trigeminal neurinoma. MethodsThe clinical manifestations, preoperative CT and MRI features, operative techniques, and outcome of 13 patients with trigeminal neurinoma were retrospectively analyzed. ResultsThe most frequent symptoms were either pain or numbness of the ipsilateral, which was due to the dysfunction of the trigeminal nerve. CT and MRI were the major means for diagnosis of the lesions. Five patients had tumors limited to the middle cranial fossa, 8 patients had dumbbell shaped tumors which extended into both the middle and posterior cranial fossa. Postoperatively, 12 of the 13 patients had either stable or improved function of cranial nerves compared with their preoperative status, and the other one worsened. Total resection of tumor was accomplished by extradural approach in 11 patients. Subtotal removal were achieved in 2 patients. None of the patients had new cranial nerves deficits after the operation. There were no perioperative deaths. Ten patients were followed-up, ranging from 6 to 36 months. None recurred. ConclusionMRI is considered the best method for diagnosing the trigeminal neuromas. It is suggested that trigeminal neuromas, either in the middle cranial fossa or both in the middle and posterior fossa, can be safely and radically removed by extradural approach, which can lead to lower morbidity and postoperative complications.