论文部分内容阅读
目的探讨海绵窦非脑膜瘤性肿瘤的鉴别诊断和手术疗效。方法回顾性分析了67例海绵窦区非脑膜瘤性肿瘤的临床表现、诊断与鉴别诊断、手术方式和疗效。67例患者中男32例,女35例,平均年龄(41±16)岁。主要临床表现有:颅神经症状47例(70.1%),内分泌症状11例(16.4%),眼痛9例(13.6%),突眼7例(10.6%),肢体乏力5例(7.5%),头痛、头昏、嗜睡、颞叶癫痫各4例(6.0%),鼻衄1例(1.5%)。所有患者术前均行CT或MRI检查,26例患者术前行数字减影血管造影检查及球囊阻塞试验。所有患者均行手术治疗。手术采用眶-颧-翼点开颅,其中以硬膜下入路手术者20例,硬膜外入路手术者33例,硬膜外与硬膜下入路相结合手术者14例。结果通过硬膜下入路手术者全切8例,次全切除者7例,大部切除者5例,分别占此组病例的40%、35%、25%。通过硬膜外手术者肿瘤全切除27例,次全切除1例,大部切除5例,分别占此组病例的81.8%、3.0%、15.2%。硬膜外与硬膜下入路相结合者(主要为侵袭性垂体瘤与哑铃型三叉神经鞘瘤)14例,其中全切除10例(71.4%),次全切除4例(28.6%)。术后随访6个月至10年,原有的神经系统症状有所恢复者39例(58.2%)。加重或新出现的神经系统症状主要为三叉神经麻痹16例(23.8%)、动眼神经麻痹13例(19.4%)及外展神经麻痹9例(13.4%)。结论根据不同的肿瘤类型及肿瘤的生长方式,选择扩大中颅底硬膜外入路,或结合硬膜下入路,可在最大限度切除肿瘤的同时,保护颅神经的功能,获得良好的手术效果。
Objective To investigate the differential diagnosis and surgical treatment of cavernous sinus non-meningioma. Methods The clinical manifestations, diagnosis and differential diagnosis of 67 cases of cavernous sinus non-meningioma were retrospectively analyzed. Among the 67 patients, 32 were male and 35 were female, with an average age of (41 ± 16) years. The main clinical manifestations were cranial nerve symptoms in 47 cases (70.1%), endocrine symptoms in 11 cases (16.4%), eye pain in 9 cases (13.6%), exophthalmos in 7 cases (10.6%) and limb weakness in 5 cases (7.5% , Headache, dizziness, drowsiness, temporal lobe epilepsy in 4 cases (6.0%), epistaxis in 1 case (1.5%). All patients underwent preoperative CT or MRI examination, 26 patients underwent preoperative digital subtraction angiography and balloon occlusion test. All patients underwent surgical treatment. Surgery with orbital zygomatic pterygoid craniotomy, including 20 cases of subdural surgery, epidural surgery in 33 cases, 14 cases of epidural and subdural approach combined surgery. Results The total subtotal approach operation in 8 cases, subtotal resection in 7 cases, 5 cases of subtotal resection, accounting for 40%, 35%, 25% of the patients in this group. Tumor resection by epidural in 27 cases of total resection, subtotal resection in 1 case, the majority of resection in 5 cases, accounting for 81.8%, 3.0%, 15.2% of this group of patients. Epidural and subdural approach combined (mainly invasive pituitary tumor and dumbbell type trigeminal nerve sheath tumor) in 14 cases, including 10 cases (71.4%) of the total resection, subtotal resection in 4 cases (28.6%). The patients were followed up for 6 months to 10 years. The original symptoms of the nervous system were recovered in 39 cases (58.2%). Symptoms of aggravating or emerging nervous system mainly include 16 cases (23.8%) of trigeminal palsy, 13 cases (19.4%) of oculomotor nerve palsy and 9 cases (13.4%) of external palsy. Conclusion Depending on the tumor type and tumor growth mode, the choice of expanding the middle cranial base epidural approach, or combined with subdural approach, can maximize the removal of the tumor at the same time, protect the function of the cranial nerves, get a good operation effect.