脑CTV评估听神经瘤与岩上窦关系的价值
|
摘要
目的探讨颅脑CT静脉成像(cerebral CT venography, CTV)术前评估听神经瘤与岩上窦、岩上静脉关系的价值。方法分析经病理证实的30例听神经瘤患者的术前CTV资料及临床资料,由2位放射科医生判定肿瘤的最大径、岩上窦引流类型,以及岩上静脉汇入岩上窦的节点与内听道后上壁的位置;进一步判断肿瘤与岩上窦的关系,分析岩上窦及岩上静脉保留情况及术后静脉并发症发生的情况,并对比肿瘤与岩上窦关系、岩上窦引流类型、岩上静脉汇入点的不同组别间肿瘤大小。结果按岩上窦引流类型分为3型:完整型、内侧型、外侧型;其中27例(90.0%)患者岩上窦为完整型;2例(6.7%)为外侧型;1例(3.3%)为内侧型。根据岩上静脉汇入岩上窦的节点与内听道后上壁的位置,分为内侧型、中间型、外侧型;11支(35.5%)岩上静脉汇入点为中间型;13支(41.9%)为内侧型;7支(22.6%)为外侧型,其中有1例患者发现两支岩上静脉,分别为内侧型、中间型。25例(83.3%)患者岩上窦走行于瘤体外侧,其中4例岩上窦受压;5例(16.7%)患者岩上窦走行于瘤体上方,岩上窦无受压。肿瘤最大径在不同肿瘤与岩上窦关系之间的差异具有统计学意义(P<0.05)。手术均采用枕下乙状窦后入路,岩上窦、岩上静脉完整保留,术后无静脉性并发症的发生。结论脑CTV可术前评估听神经瘤与岩上窦关系,有助于减少术中对岩上窦、岩上静脉的损伤。
Objective To explore the value of cerebral CT venography(CTV) in the evaluation of the relationship between acoustic neuroma and superior petrosal sinus.Methods Preoperative CTV images and clinical data of 30 cases with acoustic neuroma confirmed by pathology were analyzed retrospectively. The type of superior petrosal sinus drainage, as well as the position of the pitch point of superior petrosal vein entering superior petrosal sinus and the posterior upper wall of the internal auditory canal were determined by two radiologists. Additionally, the relationship between tumor and superior petrosal sinus was also determined. Finally, the relationship between retention of superior petrosal sinus and superior petrosal vein and the occurrence of postoperative venous complications were analyzed. The tumor size among different groups was compared.Results The drainage of superior petrosal sinus could be divided into three types, i.e. complete type, medial type and lateral type. Of the 30 cases, 27(90.0%) were complete type, 2(6.7%) were lateral, and 1(3.3%) was medial. The position of the pitch point of superior petrosal vein entering superior petrosal sinus included medial, intermediate and lateral types. Of the 30 cases, 11(35.5%) were intermediate type, 13(41.9%) were medial and 7(22.6%) were lateral. Two superior petrosal veins of intermediate type and medial type were simultaneously detected in one patient. In 25 cases(83.3%), the superior petrosal sinus was outboard of the tumor with compressed sinus in 4. In 5 cases(16.7%), the superior petrosal sinus was above the tumor and uncompressed. The difference of maximal tumor size between patient groups with different relationship of tumor and superior petrosal sinus was statistically significant(P<0.05). The suboccipital retrosigmoid approach with intact superior petrosal vein and sinus was adopted to all patients.Conclusion Cerebral CTV can be used in preoperative evaluation of the relationship between acoustic neuroma and superior petrosal sinus, which is helpful to reduce intraoperative damage to superior petrosal sinus and superior petrosal vein.
Objective To explore the value of cerebral CT venography(CTV) in the evaluation of the relationship between acoustic neuroma and superior petrosal sinus.Methods Preoperative CTV images and clinical data of 30 cases with acoustic neuroma confirmed by pathology were analyzed retrospectively. The type of superior petrosal sinus drainage, as well as the position of the pitch point of superior petrosal vein entering superior petrosal sinus and the posterior upper wall of the internal auditory canal were determined by two radiologists. Additionally, the relationship between tumor and superior petrosal sinus was also determined. Finally, the relationship between retention of superior petrosal sinus and superior petrosal vein and the occurrence of postoperative venous complications were analyzed. The tumor size among different groups was compared.Results The drainage of superior petrosal sinus could be divided into three types, i.e. complete type, medial type and lateral type. Of the 30 cases, 27(90.0%) were complete type, 2(6.7%) were lateral, and 1(3.3%) was medial. The position of the pitch point of superior petrosal vein entering superior petrosal sinus included medial, intermediate and lateral types. Of the 30 cases, 11(35.5%) were intermediate type, 13(41.9%) were medial and 7(22.6%) were lateral. Two superior petrosal veins of intermediate type and medial type were simultaneously detected in one patient. In 25 cases(83.3%), the superior petrosal sinus was outboard of the tumor with compressed sinus in 4. In 5 cases(16.7%), the superior petrosal sinus was above the tumor and uncompressed. The difference of maximal tumor size between patient groups with different relationship of tumor and superior petrosal sinus was statistically significant(P<0.05). The suboccipital retrosigmoid approach with intact superior petrosal vein and sinus was adopted to all patients.Conclusion Cerebral CTV can be used in preoperative evaluation of the relationship between acoustic neuroma and superior petrosal sinus, which is helpful to reduce intraoperative damage to superior petrosal sinus and superior petrosal vein.
引文
[1] Abou-Al-Shaar H, Gozal YM, Alzhrani G, et al. Cerebral venous sinus thrombosis after vestibular schwannoma surgery:a call for evidence-based management guidelines[J]. Neurosurg Focus,2018,45(1):E4.
[2] Narayan V, Savardekar AR, Patra DP, et al. Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review[J]. Neurosurg Focus,2018,45(6): E3.
[3] Masuoka J, Matsushima T, Hikita T, et al. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia[J]. J Clin Neurosci,2009,16(10):1342-1344.
[4] Giulio A, Mazhar I, Muhammad RN, et al. Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature[J]. Surg Neurol Int, 2016, 7(Suppl 14):S415-S420.
[5] Matsushima K, Matsushima T, Kuga Y, et al. Classification of the superior petrosal veins and sinus based on drainage pattern[J]. Neurosurgery,2014,10(Suppl 2):357-367.
[6] Corona AP, Oliveira JC, Souza FP, et al. Risk factors associated with vestibulocochlear nerve schwannoma: systematic review[J]. Braz J Otorhinolaryngol,2009,75(4):593-615.
[7] Babu R, Sharma R, Bagley JH, et al. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management[J]. J Neurosurg, 2013, 119(1):121-130.
[8] Obaid S, Nikolaidis I, Alzahrani M, et al. Morbidity rate of the retrosigmoid versus translabyrinthine approach for vestibular schwannoma resection[J]. J Audiol Otol,2018,22(4):236-243.
[9] Raza SM, Quinones-Hinojosa A. The extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification[J]. Neurosurg Rev, 2011, 34(1):123-129.
[10] Brackmann DE, Cullen RD, Fisher LM. Facial nerve function after translabyrinthine vestibular schwannoma surgery[J]. Otolaryngol Head Neck Surg, 2007, 136(5):773-777.
[11] 李嘉明, 袁贤瑞, 刘庆, 等. 大型听神经瘤手术面神经功能的保留[J]. 中华外科杂志, 2011, 49(3):240-244. Li JM, Yuan XR, Liu Q, et al. Facial nerve preservation following microsurgical removal of large and huge acoustic neuroma [J]. Chinese Journal of Surgery,2011, 49(3):240-244.
[12] Koerbel A, Gharabaghi A, Safavi-Abbasi S, et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas[J]. Eur J Surg Oncol,2009,35(7):773-779.
[13] Ebner FH, Roser F, Shiozawa T, et al. Petrosal vein occlusion in cerebellopontine angle tumour surgery: an anatomical study of alternative draining pathways[J]. Eur J Surg Oncol,2009,35(5):552-556.
[14] Venema HW, Hulsmans FJ, den Heeten GJ. CT angiography of the circle of Willis and intracranial internal carotid arteries: maximum intensity projection with matched mask bone elimination-feasibility study[J]. Radiology,2001,218(3):893-898.
[15] Kaku S, Miyahara K, Fujitsu K, et al. Drainage pathway of the superior petrosal vein evaluated by CT venography in petroclival meningioma surgery[J]. J Neurol Surg B Skull Base,2012,73(5):316-320.
[16] Adachi K, Hayakawa M, Ishihara K, et al. Study of changing intracranial venous drainage patterns in petroclival meningioma[J]. World Neurosurg,2016,92:339-348.
[17] Morisako H, Goto T, Chokyu I, et al. Preoperative evaluation of the petrosal vein with contrast-enhanced PRESTO imaging in petroclival meningiomas to establish surgical strategy[J]. Neurol Med Chir(Tokyo),2013, 53(7):490-495.
[18] Matsushima K, Ribas ES, Kiyosue H, et al.Absence of the superior petrosal veins and sinus: Surgical considerations[J]. Surg Neurol Int,2015,6(1):34.
[19] Deda H, Erden I, Yagmurlu B. Evaluation of petrosal sinus patency with 3-dimensional contrast-enhanced magnetic resonance venography in petroclival meningiomas for surgical strategy[J]. Surg Neurol,2005,64 (Suppl 2):S67-S71.
[20] Matsushima T, Rhoton AL Jr, De Oliveira E, et al. Microsurgical anatomy of the veins of the posterior fossa[J]. J Neurosurg,1983,59 (1):63-105.
[21] Tanriover N, Abe H, Rhoton AL Jr, et al. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches[J]. J Neurosurg,2007,106(6):1041-1050.
[22] 奚健,袁贤瑞.听神经瘤显微手术中岩静脉的保护[J]. 中国耳鼻咽喉颅底外科杂志,2011,17(6):425-428. Xi J, Yuan XR.The proservation of petrosal vein in operative cases of acoustic neuroma[J]. Chin J Otorhinolaryngol Skull Base Surg,2011,17(6):425-428.
[2] Narayan V, Savardekar AR, Patra DP, et al. Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review[J]. Neurosurg Focus,2018,45(6): E3.
[3] Masuoka J, Matsushima T, Hikita T, et al. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia[J]. J Clin Neurosci,2009,16(10):1342-1344.
[4] Giulio A, Mazhar I, Muhammad RN, et al. Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature[J]. Surg Neurol Int, 2016, 7(Suppl 14):S415-S420.
[5] Matsushima K, Matsushima T, Kuga Y, et al. Classification of the superior petrosal veins and sinus based on drainage pattern[J]. Neurosurgery,2014,10(Suppl 2):357-367.
[6] Corona AP, Oliveira JC, Souza FP, et al. Risk factors associated with vestibulocochlear nerve schwannoma: systematic review[J]. Braz J Otorhinolaryngol,2009,75(4):593-615.
[7] Babu R, Sharma R, Bagley JH, et al. Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management[J]. J Neurosurg, 2013, 119(1):121-130.
[8] Obaid S, Nikolaidis I, Alzahrani M, et al. Morbidity rate of the retrosigmoid versus translabyrinthine approach for vestibular schwannoma resection[J]. J Audiol Otol,2018,22(4):236-243.
[9] Raza SM, Quinones-Hinojosa A. The extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification[J]. Neurosurg Rev, 2011, 34(1):123-129.
[10] Brackmann DE, Cullen RD, Fisher LM. Facial nerve function after translabyrinthine vestibular schwannoma surgery[J]. Otolaryngol Head Neck Surg, 2007, 136(5):773-777.
[11] 李嘉明, 袁贤瑞, 刘庆, 等. 大型听神经瘤手术面神经功能的保留[J]. 中华外科杂志, 2011, 49(3):240-244. Li JM, Yuan XR, Liu Q, et al. Facial nerve preservation following microsurgical removal of large and huge acoustic neuroma [J]. Chinese Journal of Surgery,2011, 49(3):240-244.
[12] Koerbel A, Gharabaghi A, Safavi-Abbasi S, et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas[J]. Eur J Surg Oncol,2009,35(7):773-779.
[13] Ebner FH, Roser F, Shiozawa T, et al. Petrosal vein occlusion in cerebellopontine angle tumour surgery: an anatomical study of alternative draining pathways[J]. Eur J Surg Oncol,2009,35(5):552-556.
[14] Venema HW, Hulsmans FJ, den Heeten GJ. CT angiography of the circle of Willis and intracranial internal carotid arteries: maximum intensity projection with matched mask bone elimination-feasibility study[J]. Radiology,2001,218(3):893-898.
[15] Kaku S, Miyahara K, Fujitsu K, et al. Drainage pathway of the superior petrosal vein evaluated by CT venography in petroclival meningioma surgery[J]. J Neurol Surg B Skull Base,2012,73(5):316-320.
[16] Adachi K, Hayakawa M, Ishihara K, et al. Study of changing intracranial venous drainage patterns in petroclival meningioma[J]. World Neurosurg,2016,92:339-348.
[17] Morisako H, Goto T, Chokyu I, et al. Preoperative evaluation of the petrosal vein with contrast-enhanced PRESTO imaging in petroclival meningiomas to establish surgical strategy[J]. Neurol Med Chir(Tokyo),2013, 53(7):490-495.
[18] Matsushima K, Ribas ES, Kiyosue H, et al.Absence of the superior petrosal veins and sinus: Surgical considerations[J]. Surg Neurol Int,2015,6(1):34.
[19] Deda H, Erden I, Yagmurlu B. Evaluation of petrosal sinus patency with 3-dimensional contrast-enhanced magnetic resonance venography in petroclival meningiomas for surgical strategy[J]. Surg Neurol,2005,64 (Suppl 2):S67-S71.
[20] Matsushima T, Rhoton AL Jr, De Oliveira E, et al. Microsurgical anatomy of the veins of the posterior fossa[J]. J Neurosurg,1983,59 (1):63-105.
[21] Tanriover N, Abe H, Rhoton AL Jr, et al. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches[J]. J Neurosurg,2007,106(6):1041-1050.
[22] 奚健,袁贤瑞.听神经瘤显微手术中岩静脉的保护[J]. 中国耳鼻咽喉颅底外科杂志,2011,17(6):425-428. Xi J, Yuan XR.The proservation of petrosal vein in operative cases of acoustic neuroma[J]. Chin J Otorhinolaryngol Skull Base Surg,2011,17(6):425-428.