枕下远外侧入路手术切除颅颈交界区腹侧及腹外侧肿瘤
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摘要
目的探讨枕下远外侧入路在颅颈交界区腹侧及腹外侧肿瘤切除术中的应用效果。方法回顾性分析2012年12月至2017年12月采用枕下远外侧入路手术治疗的17例颅颈交界区(腹侧3例,腹外侧14例)肿瘤的临床资料。结果 17例术中均暴露良好、充分。14例肿瘤全切(9例脑膜瘤、5例神经鞘瘤),2例脊索瘤及1例骨源性肿瘤次全切除。术后7例出现原有后组神经功能障碍加重,3例出现新的后组神经功能障碍,术后6个月内恢复8例,2例残留永久性神经功能障碍。术后发生脑脊液漏3例、颅内感染2例,均经积极治疗后好转,无术后颅内血肿、脑积水及临床死亡病例。术后随访0.5～31个月,1例脊索瘤复发。结论枕下远外侧入路手术是切除颅颈交界区腹侧及腹外侧肿瘤的安全、有效的方法,可依据病灶情况采取个体化的术式。
Objective To discuss the application of the suboccipital far-lateral approach to neurosurgery for the ventral and ventrolateral tumors in the craniocervical junctions. Methods The clinical data of 17 patients with ventral and ventrolateral tumors in the craniocervical junctions who underwent neurosurgery via suboccipital far-lateral approach from December, 2012 to December, 2017 were analyzed retrospectively. Results Of the 17 patients, 14 received total removal of the tumors and 3 including 2 with chordomas and1 with estrogenic tumor received subtotal removal of the tumors. Of 10 patients including 7 patients with postoperative cranial nerve dysfunction and 3 patients with postoperative new cranial nerve dysfunction, 8 were recovered from cranial nerve dysfunction 6 months after the operation and 2 had permanent cranial nerve dysfunction. Three patients with postoperative cerebrospinal fluid leakage and 2 with intracranical infection were cured by active corresponding treatment. There were no intracranial hematoma, hydrocephalus and death after the operation in all the patients. Conclusion The neurosurgery via the suboccipital far-lateral approach is a safe and effective method to remove the ventral and ventrolateral tumors in the craniocervical junctions. Individualized surgical procedures should be adopted according to the characteristics of each patient with the craniocervical junction tumor.
Objective To discuss the application of the suboccipital far-lateral approach to neurosurgery for the ventral and ventrolateral tumors in the craniocervical junctions. Methods The clinical data of 17 patients with ventral and ventrolateral tumors in the craniocervical junctions who underwent neurosurgery via suboccipital far-lateral approach from December, 2012 to December, 2017 were analyzed retrospectively. Results Of the 17 patients, 14 received total removal of the tumors and 3 including 2 with chordomas and1 with estrogenic tumor received subtotal removal of the tumors. Of 10 patients including 7 patients with postoperative cranial nerve dysfunction and 3 patients with postoperative new cranial nerve dysfunction, 8 were recovered from cranial nerve dysfunction 6 months after the operation and 2 had permanent cranial nerve dysfunction. Three patients with postoperative cerebrospinal fluid leakage and 2 with intracranical infection were cured by active corresponding treatment. There were no intracranial hematoma, hydrocephalus and death after the operation in all the patients. Conclusion The neurosurgery via the suboccipital far-lateral approach is a safe and effective method to remove the ventral and ventrolateral tumors in the craniocervical junctions. Individualized surgical procedures should be adopted according to the characteristics of each patient with the craniocervical junction tumor.
引文
[1]刘佳,陈治标,王军民,等.远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术探讨(附11例报告)[J].中国临床神经外科杂志,2012,17(6):331-333.
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[9]Salas E,Sekhar LN,Ziyal IM,et al.Variations of the extreme-lateral craniocervical approach:anatomical study and clinical analysis of 69 patients[J].J Neurosurg,1999,90(2 Suppl):206-219.
[10]George B,Lot G,Velut S,et al.French language Society of Neurosurgery.44th Annual Congress.Brussels,8-12 June1993.Tumors of the foramen magnum[J].Neurochirurgie,1993,39 Suppl 1:1-89.
[2]Komotar RJ,Zacharia BE,McGovern RA,et al.Approaches to anterior and anterolateral foramen magnum lesions:a critical review[J].J Craniovertebr Junction Spine,2010,1(2):86-99.
[3]Love JG,Thelen EP,Dodge HW.Tumors of the foramen magnum[J].J Int Coll Surg,1954,22(11):1-17.
[4]Frazier CH,Spiller WG.An analysis of fourteen consecutive cases of spinal cord tumor[J].JAMA,1922,79(13):1024.
[5]Kassam A,Snyderman CH,Mintz A,et al.Expanded endonasal approach:the rostrocaudal axis:PartⅠ.Crista galli to the sella turcica[J].Neurosurg Focus,2005,19:E3 1-12.
[6]Kassam A,Snyderman CH,Mintz A,et al.Expanded endonasal approach:the rostrocaudal axis:PartⅡ.Posterior clinoids to the foramen magnum[J].Neurosurg Focus,2005,19(1):E4 1-47.
[7]Heros RC.Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions[J].J Neurosurg,1986,64(4):559-562.
[8]George B,Dematons C,Cophignon J.Lateral approach to the anterior portion of the foramen magnum:application to surgical removal of 14 benign tumors--technical note[J].Surg Neurol,1988,29(6):484-490.
[9]Salas E,Sekhar LN,Ziyal IM,et al.Variations of the extreme-lateral craniocervical approach:anatomical study and clinical analysis of 69 patients[J].J Neurosurg,1999,90(2 Suppl):206-219.
[10]George B,Lot G,Velut S,et al.French language Society of Neurosurgery.44th Annual Congress.Brussels,8-12 June1993.Tumors of the foramen magnum[J].Neurochirurgie,1993,39 Suppl 1:1-89.