73例桥小脑角区巨大肿瘤的诊治分析

Experience in diagnosing and treating 73 patients with giant tumor of the cerebellopontine angle

目的 :总结桥小脑角区巨大肿瘤的诊治经验。方法 :对我科 73例桥小脑角区巨大肿瘤的发病率、临床和影像学表现、定位与定性诊断、手术治疗及随访期心理治疗等作分析。结果 :本组 73例桥小脑角巨大肿瘤 (均≥ 4cm)中 ,属神经鞘瘤 50例 (68.5% )、脑膜瘤 1 9例(2 6.0 % )与胆脂瘤 4例 (5.5% )。临床特点 :73例均有颅神经、小脑损害的症状与体征及颅内高压征。73例中手术全切除者 60例、次全切除1 3例 (其中 1 0例残留肿瘤 ,结合伽玛刀治疗 )。全切除组中 2例死于肺部感染 ,次全切除组中 3例放弃治疗 ,余者随访 3～ 5 a,无复发。在颅神经损伤所致并发症的 56例中 ,出现心身疾病须心理治疗者 40例 (71 .4% )。结论 :临床特点结合影像学检查可作出早期定位与定性诊断 ,并有助于手术设计。提高疗效的关键是早诊断、早治疗以及娴熟的显微操作技术。手术结合伽玛刀以及心理治疗可改善预后、提高生存质量。

Objective:To summarize the experience in the diagnosis and treatment of giant tumor in the cerebellopontine angle.Methods:Clinical data of 73 patients with giant tumor (the diameter being 4 cm or more)of the cerebellopontine angle were analyzed retrospectively.Results:There were 50(68.5%)schwannomas,19(26.0%)meningiomas and 4(5.5%)cholesteatomas.All patients presented with cranial nerve deficits,cerebellar neuropathy and intracranial hypertension.Sixty tumors were excised completely,and thirteen subtotally.Ten subtotally excised tumors underwent gamma knife radiosurgery following surgery.Two of the 60 patients with completely removed tumor died of postoperative pneumonia,and three of the 13 patients with subtotally removed tumor gave up therapy;the remainder were followed up from 3 to 5 years,and there was no recurrence.Forty(71.4%)of the 56 patients with cranial nerve deficits had psychosomatic diseases requiring psychotherapy.Conclusion:Clinical characteristic and radiography(CT and MRI)are imporant in early diagnosis and operative design.Early diagnosis and treatment,and the use of the surgical microscope and microtechnique are crucial factors contributing to good results.The combination of operation and gamma knife radiosurgery,and postoperative psychotherapy could improve the prognosis and the quality of life.