摘要
目的总结、分析蝶鞍外侧间隙海绵状血管瘤(LSCC)的研究历程,重点阐述对 LSCC的新认识和最新显微外科策略。方法根据 LSCC 认识的不同时期,将其分为4个阶段,共102例病人,其中第1阶段32例,第2阶段18例,第3阶段36例,第4阶段16例。逐一分析各阶段研究的进展状况,包括神经影像学、解剖学、病理学等,重点总结相应阶段外科处理措施的利弊得失。结果第1、2、3、4阶段肿瘤全切除例数分别为4、5、17及12,次全切除例数分别为3、4、10及2。余皆为部分切除。术中失血量及手术致残率均在第4阶段得到明显改观。术后主要并发症为动眼神经麻痹、外展神经麻痹和三叉神经损伤。全组无手术死亡病例。结论随着 LSCC 认识的逐步深入,其外科治疗亦日臻成熟。术中控制性降压、硬脑膜外入路手术切除应为 LSCC 首选治疗方法。
Objective To summarize and analyze the surgical treatment of lateral sellar compartment cavernoma（LSCC）. Methods The clinical data of 102 patients with LSCC who underwent surgical treatment from 1958 to 2006, 2 males and 80 females, aged 43.5 （ 11 - 69 ）, were collected and analyzed. The operation patterns were divided into 4 stages based on the understanding of LSCC ： first stage （1958 - 1988, with 32 cases） during which diagnosis was mainly bases on X-ray plain films, CT, and ordinary cerebral angiography, and most of the tumors were partially excised; second stage （ 1989 - 1997, with 18 cases） during which MRI, DSA, and microsurgery were widely used; third stage （ 1998 - 2003, with 36 cases） during which the neurological anatomy of the LSC and pathology of LSCC made headway, however, intra-operational bleeding was still a problem, and fourth stage （2004 - 2006, with 16 cases） during which relevant models were basically understood. Results Post-operative MRI shoed that the tumor complete resection rates of the 4 stages were 4/32, 5/18, 17/36, and 12/16, and the subtotal resection rates were 3/32, 4/18, 10/36, and 2/16 respectively. The rest of the tumors were all partially removed. Not only the intra-operative blood loss but also the cranial nerve morbidity rate decreased dramatically in the 4th stage. The main postoperative complications included oculomotor nerve paralysis, abducent nerve palsy, and trigeminal nerve damages. No operation-related death occurred. Conclusion Following the progress of LSCC study, the treatment of LSCC becomes mature. Radical removal of LSCC may be the best choice for LSCC patients by epidural approach via the skull base craniotomy with induced hypotension.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第13期868-871,共4页
National Medical Journal of China
关键词
血管瘤
海绵状
海绵窦
蝶鞍外侧间隙
外科
Cavernoma
Lateral sellar compartment
Cavernous sinus
Surgery
