摘要
目的 探讨海绵窦 (CS)病变的手术疗效、方法及影响肿瘤切除的因素。方法 5 8例 CS病变患者施行经颅手术治疗 ,其中 CS内动静脉瘘 (AVF) 11例 ,CS内异物 (铅弹 ) 2例 ,CS肿瘤 4 5例。手术经额颞翼点开颅36例 ,额颞眶 -颧弓开颅 14例 ,幕上幕下联合经岩骨开颅 8例 ;手术入路采用经 CS上壁上方入路及经 CS外侧壁侧方入路。行肿瘤全切 2 8例 ,部分及次全切 17例 ;对 AVF者用止血海绵填塞 CS静脉间隙 ;对 CS内铅弹经Parkinson三角取出。结果 肿瘤全切率为 6 3.2 % ,次全切及部分切除率为 36 .8% ;9例 CS内 AVF患者的漏口完全消失 ,2例漏口部分消失者又行血管内栓塞治疗 ;2例 CS内异物者均取出铅弹。 1例脑膜瘤患者术后 1周死于脑栓塞 ,出现动眼及外展神经功能障碍各 6例。结论 CS病变手术疗效满意 ,并发症少。对术后影像学证实有残余肿瘤者 ,应行放疗或放射外科治疗。影响 CS内肿瘤切除的因素主要为肿瘤性质。
Objective To explore the operative methods,operative effect and factors influencing the resectability of intracavernous lesions Methods 58 patients with intracavernous lesions were transcranially operated on microsurgery,of whom 11 with cavernous sinus(CS) dural arteriovenous fistulae(AVF), 2 with CS foreign body (plumbeous bullet), 45 with CS tumors The operations were carried out by frontotemporal craniotomy in 36 cases, by frontotemporal orbitozygomatic craniotomy in 14 cases, by combined supra infra tentorial transpetrousal craniotomy in 8 cases The approachs into the CS included the superior approach through its superior wall, the ateral (intra and extra) approach through its lateral wall In dural AVF the venous space of the CS was filled with hemostatic sponge The bullet was removed through the Parkinson triangle Results In tumor cases,28(63 2%)were resected totally, 17(36 8%) were resected subtotally or partially The fistulae were disappeared totally in 9 cases, the other 2 cases only partially disappeared and successive endovascular therapy was introduced Only 1 patient was dead because of the occlusion of the middle cerebral artery in the second postoperative week Deficit of the 3rd and/or 6th nerves appeared with their normal preoperative function in 12 cases Conclusion Overall, the operative effect of CS lesions is good with acceptable complications For the remnant tumors confirmed by the postoperative images,the conventional radiotherapy or radiosurgery are recommended The factors affecting the tumor resectability of the CS are the nature of the tumor, the second operation or preoperative radiotherapy and the involving range of the tumor,etc
出处
《山东医药》
CAS
北大核心
2004年第3期1-3,共3页
Shandong Medical Journal
