摘要
目的探讨颈静脉孔区肿瘤的临床表现、影像学特征、手术方法、治疗结果以及少见特殊病理类型肿瘤的临床特征，分析术前评估、围手术期处理、手术技术与经验对全切肿瘤及预防并发症的意义。方法回顾性分析1985年至2007年42例颈静脉孔区肿瘤的临床资料，包括31例颈静脉球瘤和11例特殊病理类型肿瘤。术前均进行系统的颞骨影像学检查，并根据情况选择血管造影和肿瘤供血血管栓塞。颈静脉球瘤的切除选择颞下窝A入路或联合耳蜗迷路入路，特殊病理类型肿瘤选择颞下窝A型入路、扩大乳突切除或乳突颈侧入路。结果42例肿瘤分类均为Fisch分型C类以上，均已侵犯后颅窝。31例颈静脉球瘤主要临床表现为耳鸣、听力下降、周围性面神经麻痹；11例特殊类型肿瘤临床表现不具特征性，其中5例为CT及MRI检查偶然发现。本组肿瘤的全切率为81％（34／42）。面神经的处理方式包括永久性面神经向前移位19例，保留面神经骨桥16例，神经间位移植4例，面-副神经吻合2例和面-舌下神经吻合1例。结论颈静脉孔区肿瘤的手术入路选择取决于术前评估的结果，肿瘤的侵犯范围、特点、面神经及颈内动脉受累的情况是评估的重要内容。颞下窝A型入路可满足大多数颈静脉孔区肿瘤的切除要求。对于可能需要牺牲颈内动脉的病例，术前必须进行球囊栓塞试验。
Objective To report the clinical manifestations, imaging characteristics, surgical approaches, managements, and outcome of jugular foramen tumors. The detailed clinical information of this extremely rare tumor was presented , with special emphasis on certain key issues, e. g, the preoperative estimation, perioperative management, surgical skill and experience, which exerted an influence on the significance of total tumor resection and preventing complications. Methods From 1985 to 2007, 42 patients with jugular foramen tumor （ 30 cases of jugular paragangliomas and 11 cases of tumor with particular pathological types ） were enrolled in this study. Prior to surgical procedures, all patients were subjected to systematic imaging examinations on temporal bone, such as CT, HRCT, CTA ,and MRI, and some patients were further examined by angiography or embolization according to the individual situations. The infratemporal type A and combined translabrinthin and/or transchecholea approaches were selected for the treatment of 30 cases of jugular paragangliomas; while, the modalities of infratemporal type A, enlarged mastoidectomy, or mastoid-neck approach were employed for the remaining 11 specific cases. Results Forty-two patients in this report were categorized into beyond C types based on FISCH classification in which all had invaded to posterior fossa. In the 31 cases, the major initial clinical symptoms were tinnitus, hearing loss, and facial palsy ; while,in the 11 specific cases, the main symptoms did not possess any unique trait for the diagnosis and 5 of which were found via CT or MRI examination by chance. Facial nerve management included permanent anterior transposition （ 19 cases）, facial nerve bridge technology （ 16 cases）, interposition graft （ 4 cases） , Ⅶ-Ⅺ jump graft （ 2 cases） , and Ⅶ-Ⅻ anastomosis （ 1 case ） . Conclusions The preoperative estimation of tumor in nature was of great importance in the determination of proper surgical approaches and the infratemporal type A could fully meet the requirement for resection of tumors in jugular foramen. Facial nerve anterior rerouting could provide a clear visual field during the procedure, especially for the lesions in anterior tympanic cavity. In most cases, the facial nerve bridge technology could also fulfill the needs for complete tumor resection as well as the better preservation of facial function. In case of considering the sacrifice of internal carotid artery, balloon test occlusion was indispensable for preoperative estimation. The CT or MRI characteristics of tumors with particular pathological types were different from those of jugular paragangliomas. The preoperative management, surgical skills, and experience played a pivotal role in complete tumor resection.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第8期570-576,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
颈静脉球瘤
耳外科手术
颅底肿瘤
Glomus jugulare tumor
Otologic surgical procedures
Meningioma
