三叉神经鞘瘤的诊断和显微手术治疗
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摘要
目的探讨三叉神经鞘瘤的诊断和手术治疗。方法复习文献并回顾性总结分析广西医科大学第一附属医院神经外科自2003年1月至2010年12月采用显微手术治疗的41例三叉神经鞘瘤患者的临床表现,影像学特征,手术方式及疗效。
结果三叉神经鞘瘤患者的临床表现以患侧的三叉神经症状及体征为主,常同时伴有Ⅲ、Ⅳ、Ⅵ、Ⅶ、Ⅷ颅神经受损,头颅CT和MRI对临床诊断及病变累及范围有重要意义。本组病例中颅窝(M)型3例,后颅窝(P)型8例,Mp型8例,M=P型12例,Pm型6例,中颅窝颅外(ME)型2例,中后颅窝颅外(MPE)型2例。本组病例采用断或不断颧弓的额颞硬膜外入路13例,颞底-天幕入路14例,乙状窦前入路3例,乙状窦后入路11例。35例全切,5例次全切,1例大部分切。术后颅内感染2例,脑脊液耳漏2例,颅内血肿2例,术后脑积水1例,肺部感染1例。术后新出现颅神经障碍13例,原有颅神经障碍加重者4例,涉及Ⅲ、Ⅳ、V、VI、Ⅶ、Ⅸ、Ⅹ颅神经。其余颅神经损害较术前均有好转。术前突眼征病例术后明显缓解。而高颅压征,锥体束征,小脑征及面部疼痛术后均得以缓解。术后随访13例,时间为3月~7年,其中2例复发。
结论三叉神经鞘瘤有其明显的临床表现,但常被忽略,以患侧的三叉神经症状和体征及其临近颅神经、脑叶受累为主,结合头颅影像学的特征性表现,一般能做出正确诊断。需与脑膜瘤、听神经瘤和胆脂瘤鉴别。手术入路的方式,应根据肿瘤的类型,累及的结构选择。我们建议:对中颅窝为主的三叉神经鞘瘤(包括M型、Mp型、ME型),采用断或不断颧弓的额颞硬膜外入路,对中后颅窝均较大的M=P型采用颞底-天幕入路,对Pm型采用乙状窦前或乙状窦后入路,对P型采用乙状窦后入路,术野显露好,有助于提高肿瘤的全切率、降低病残率。
Objective To investigate the diagnosis and the microsurgical management of trigeminal neurinomas.
Methods Between January 2003 and December 2010, 41 patients with trigeminal neurinomas were managed with different microsurgical methods in the neurosurgery department in the First Affiliated Hospital of GuangXi Medical University, whose clinical manifestations, preoperative CT and MRI features, operative techniques and outcome were retrospectively analyzed. In the meantime, the relating reports of trigeminal neurinomas in the current literature were reviewed.
Results The most frequent symptoms and signs were numbness and/or paraesthesia in one or more of the three trigeminal branches of the ipsilateral, which was frequently accompanied with the damage of oculomotor nerve, trochlear nerve , abducens nerve, facial nerve and vestibulocochlear nerve .The head CT and MRI were the major means for diagnosis of the lesions. There were 3 Type M tumors , 8 Type P tumors, 8 Type Mp tumors , 12 Type M=P tumors, 6 Type Pm tumors, 2 Type ME tumors and 2 Type MPE tumors. 13 patients were managed with Frontotemporal Epidural Approach with or without zygomatic osteotomy,14 patients with Subtemporal Transtentoria Aproach, 3 patients with Presigmoid Approach, 11 patients with Retrosigmoid Approach. Total resection was achieved in 35 patients , subtotal resection in 5 patients and partial resection in 1 patient. Bacterial meningitis, cerebrospinal fluid leakages and intracranial hematoma occurred in 2 cases respectively, pulmonary infections in 1 case. 13 patients with new incomplete paralysis of cranial nerve and 4 patients with cranial nerves deficits worsened after operation included oculomotor nerves, trochlear nerve, trigeminal nervs, abducens nerves, facial nerves and glossopharyngeal and vagus nerves . The rest damaged nerves were improved postoperatively. The symptoms and signs included exophthalmos, cerebellar ataxia, hypertensive intracranial syndrome, facial pain, hemiparesis obviously alleviated. 13 patients were followed up for 3 months to 7 years , tumor recurrence was found in 2 cases .
Conclusion There are characteristic clinical manifestations in the patients with trigeminal neurinomas, whose most frequent symptoms are numbness and/or paraesthesia in one or more of the three trigeminal branches of the ipsilateral, which is frequently accompanied with the damage of the adjacent nerves and/or the adjacent brain tissue. A proper diagnosis is based on the characteristic clinical manifestations and the head imaging features. It is indispensable to distinguish from meningeoma, acoustic neurinoma and cholesteatoma. The basis of choosing individual surgical approach is the tumor type and the adjacent tissue. It is optimal to remove the mainly Type M tumor(include Type M tumor, Type Mp tumor, Type ME tumor) via Frontotemporal Epidural Approach with or without zygomatic osteotomy , the Type M=P tumor via Subtemporal Transtentoria Aproach, the Type Pm tumor via Presigmoid Approach or Retrosigmoid Approach, the Type P tumor via Retrosigmoid Approach. It can provide better exposure of these tumors and improve the surgical results in terms of increased complete tumor resection rate and reduced complications rate.
结果三叉神经鞘瘤患者的临床表现以患侧的三叉神经症状及体征为主,常同时伴有Ⅲ、Ⅳ、Ⅵ、Ⅶ、Ⅷ颅神经受损,头颅CT和MRI对临床诊断及病变累及范围有重要意义。本组病例中颅窝(M)型3例,后颅窝(P)型8例,Mp型8例,M=P型12例,Pm型6例,中颅窝颅外(ME)型2例,中后颅窝颅外(MPE)型2例。本组病例采用断或不断颧弓的额颞硬膜外入路13例,颞底-天幕入路14例,乙状窦前入路3例,乙状窦后入路11例。35例全切,5例次全切,1例大部分切。术后颅内感染2例,脑脊液耳漏2例,颅内血肿2例,术后脑积水1例,肺部感染1例。术后新出现颅神经障碍13例,原有颅神经障碍加重者4例,涉及Ⅲ、Ⅳ、V、VI、Ⅶ、Ⅸ、Ⅹ颅神经。其余颅神经损害较术前均有好转。术前突眼征病例术后明显缓解。而高颅压征,锥体束征,小脑征及面部疼痛术后均得以缓解。术后随访13例,时间为3月~7年,其中2例复发。
结论三叉神经鞘瘤有其明显的临床表现,但常被忽略,以患侧的三叉神经症状和体征及其临近颅神经、脑叶受累为主,结合头颅影像学的特征性表现,一般能做出正确诊断。需与脑膜瘤、听神经瘤和胆脂瘤鉴别。手术入路的方式,应根据肿瘤的类型,累及的结构选择。我们建议:对中颅窝为主的三叉神经鞘瘤(包括M型、Mp型、ME型),采用断或不断颧弓的额颞硬膜外入路,对中后颅窝均较大的M=P型采用颞底-天幕入路,对Pm型采用乙状窦前或乙状窦后入路,对P型采用乙状窦后入路,术野显露好,有助于提高肿瘤的全切率、降低病残率。
Objective To investigate the diagnosis and the microsurgical management of trigeminal neurinomas.
Methods Between January 2003 and December 2010, 41 patients with trigeminal neurinomas were managed with different microsurgical methods in the neurosurgery department in the First Affiliated Hospital of GuangXi Medical University, whose clinical manifestations, preoperative CT and MRI features, operative techniques and outcome were retrospectively analyzed. In the meantime, the relating reports of trigeminal neurinomas in the current literature were reviewed.
Results The most frequent symptoms and signs were numbness and/or paraesthesia in one or more of the three trigeminal branches of the ipsilateral, which was frequently accompanied with the damage of oculomotor nerve, trochlear nerve , abducens nerve, facial nerve and vestibulocochlear nerve .The head CT and MRI were the major means for diagnosis of the lesions. There were 3 Type M tumors , 8 Type P tumors, 8 Type Mp tumors , 12 Type M=P tumors, 6 Type Pm tumors, 2 Type ME tumors and 2 Type MPE tumors. 13 patients were managed with Frontotemporal Epidural Approach with or without zygomatic osteotomy,14 patients with Subtemporal Transtentoria Aproach, 3 patients with Presigmoid Approach, 11 patients with Retrosigmoid Approach. Total resection was achieved in 35 patients , subtotal resection in 5 patients and partial resection in 1 patient. Bacterial meningitis, cerebrospinal fluid leakages and intracranial hematoma occurred in 2 cases respectively, pulmonary infections in 1 case. 13 patients with new incomplete paralysis of cranial nerve and 4 patients with cranial nerves deficits worsened after operation included oculomotor nerves, trochlear nerve, trigeminal nervs, abducens nerves, facial nerves and glossopharyngeal and vagus nerves . The rest damaged nerves were improved postoperatively. The symptoms and signs included exophthalmos, cerebellar ataxia, hypertensive intracranial syndrome, facial pain, hemiparesis obviously alleviated. 13 patients were followed up for 3 months to 7 years , tumor recurrence was found in 2 cases .
Conclusion There are characteristic clinical manifestations in the patients with trigeminal neurinomas, whose most frequent symptoms are numbness and/or paraesthesia in one or more of the three trigeminal branches of the ipsilateral, which is frequently accompanied with the damage of the adjacent nerves and/or the adjacent brain tissue. A proper diagnosis is based on the characteristic clinical manifestations and the head imaging features. It is indispensable to distinguish from meningeoma, acoustic neurinoma and cholesteatoma. The basis of choosing individual surgical approach is the tumor type and the adjacent tissue. It is optimal to remove the mainly Type M tumor(include Type M tumor, Type Mp tumor, Type ME tumor) via Frontotemporal Epidural Approach with or without zygomatic osteotomy , the Type M=P tumor via Subtemporal Transtentoria Aproach, the Type Pm tumor via Presigmoid Approach or Retrosigmoid Approach, the Type P tumor via Retrosigmoid Approach. It can provide better exposure of these tumors and improve the surgical results in terms of increased complete tumor resection rate and reduced complications rate.
引文
1. Dixon J. Tumor of gassserian ganglion. Med Clin Trans London. 1846;29:131.
2. Samii M, Migliori M, Tatagiba M etc. Surgical treatment of trigeminal schwannomas. Journal of Neurosurgery: Pediatrics. 1995;82(5):37-41.
3. Taha J, Tew Jr J, van Loveren H etc. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. Journal of neurosurgery. 1995;82(5):719-725.
4. Frazier C. An operable tumor involving the Gasserian ganglion. The Journal of Nervous and Mental Disease. 1919;50(1):74.
5. Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clinical neurosurgery. 1953;1:11.
6. Schisano G, Olivecrona H. Neurinomas of the Gasserian ganglion and trigeminal root. Journal of neurosurgery. 1960;17:306.
7. Konovalov A, Spallone A, Mukhamedjanov D etc. Trigeminal neurinomas a series of 111 surgical cases from a single institution. Acta neurochirurgica. 1996;138(9):1027-1035.
8. Sarma S, Sekhar L, Schessel D. Nonvestibular schwannomas of the·brain: a 7-year experience. Neurosurgery. 2002;50(3):437.
9. Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. Journal of neurosurgery. 1999;91(2):202-211.
10. Gwak H, Hwang S, Paek S etc. Long-term outcome of trigeminal neurinomas with modified classification focusing on petrous erosion* 1. Surgical neurology. 2003;60(1):39-48.
11. Dolenc V. Frontotemporal epidural approach to trigeminal neurinomas. Actaneurochirurgica. 1994;130(1):55-65.
12.徐启武,车晓明.三叉神经鞘瘤的诊断与手术入路选择.中华神经外科疾病研究杂志. 2002;1(004):320-322.
13. MacNally S, Rutherford S, Ramsden R etc. Trigeminal schwannomas. British Journal of Neurosurgery. 2008;22(6):729-738.
14. Goel A, Muzumdar D. Trigeminal neurinomas: surgical considerations. Cavernous Sinus. 2009:163.
15. Goel A, Shah A, Muzumdar D etc. Trigeminal neurinomas with extracranial extension: analysis of 28 surgically treated cases. Journal of neurosurgery. 2009:1-6.
16. Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52(4):783.
17. Machado AG, Aguiar PH, Marino Jr R. Pathological laughter in a patient with trigeminal neurinoma. Arquivos de Neuro-Psiquiatria. 2002;60:1000-1002.
18. Jagetia A, Pratap Kumar N, Singh D etc. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurgical review. 2006;29(4):348-352.
19.孟莉.颅内三叉神经鞘瘤的CT及MRI诊断.中国耳鼻咽喉颅底外科杂志. 2007;13(003):203-205.
20.王卫斌,林志春,曲华丽等.颅内三叉神经鞘瘤的MRI诊断及鉴别诊断.医学影像学杂志. 2008;18(012):1359-1361.
21.江桂华,田军章,陈喜兰等.海绵窦海绵状血管瘤及其影像学特点.国外医学:脑血管疾病分册. 2005;13(012):907-910.
22.段刚,彭旭红.中颅窝区脑外肿瘤的MRI表现. CHINESE JOURNAL OF NEUROMEDICINE. 2009;8(7):86-89.
23.刘志雄,袁贤瑞.三叉神经鞘瘤的诊断与手术治疗.中国耳鼻咽喉颅底外科杂志. 2002;8(004):217-219.
24.刘国江,伍小红,瞿浩.以多发性硬化为表现的三叉神经鞘瘤1例.疑难病杂志. 2008;7(005):305-306.
25.袁进国,于明克,王子文.桥小脑角区血管周细胞瘤误诊为三叉神经鞘瘤l例.中国肿瘤临床与康复. 2007;8(3):23.
26. Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. Journal of Neurosurgery: Pediatrics. 2002;96(3):35-38.
27.周良辅,毛颖.哑铃状三叉神经鞘瘤的外科治疗.中华外科杂志. 2002;40(002):81-83.
28.刘志雄,袁贤瑞,刘景平等.中颅窝底硬膜外入路显微手术切除三叉神经鞘瘤.湖南医科大学学报. 2003;28(003):295-297.
29.徐淑军,李新钢,周茂德等.三叉神经鞘瘤的手术入路探讨.中华神经外科杂志. 2005;21(009):539-541.
30.潘力雄,刘运生,陈忠平等.扩大翼点入路切除前中颅底病灶的临床体会.中华神经医学杂志. 2005;4(010):1032-1033.
31.江涛,于春江.听神经瘤枕下乙状窦后开颅技术的改进临床研究.中国微侵袭神经外科杂志. 2001;6(001):19-21.
32.徐启武,车晓明.中,后颅窝型三叉神经经鞘瘤的诊断与治疗.中国神经精神疾病杂志. 2002;28(006):443-445.
33.徐启武.颅底手术彩色图谱:天津,天津科学技术出版社; 2000:305-308.
1. Dixon J. Tumor of gassserian ganglion. Med Clin Trans London. 1846;29:131.
2. Samii M, Migliori M, Tatagiba M, et al. Surgical treatment of trigeminal schwannomas. Journal of Neurosurgery: Pediatrics. 1995;82(5):37-41.
3. Taha J, Tew Jr J, van Loveren H, et al. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. Journal of neurosurgery. 1995;82(5):719-725.
4. Frazier C. An operable tumor involving the Gasserian ganglion. The Journal of Nervous and Mental Disease. 1919;50(1):74.
5. Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clinical neurosurgery. 1953;1:11.
6. Schisano G, Olivecrona H. Neurinomas of the Gasserian ganglion and trigeminal root. Journal of neurosurgery. 1960;17:306.
7. Konovalov A, Spallone A, Mukhamedjanov D, et al. Trigeminal neurinomas a series of 111 surgical cases from a single institution. Acta neurochirurgica. 1996;138(9):1027-1035.
8. Sarma S, Sekhar L, Schessel D. Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery. 2002;50(3):437.
9. Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. Journal of neurosurgery. 1999;91(2):202-211.
10. Gwak H, Hwang S, Paek S, et al. Long-term outcome of trigeminal neurinomas with modified classification focusing on petrous erosion* 1.Surgical neurology. 2003;60(1):39-48.
11. Dolenc V. Frontotemporal epidural approach to trigeminal neurinomas. Acta neurochirurgica. 1994;130(1):55-65.
12.徐启武,车晓明.三叉神经鞘瘤的诊断与手术入路选择.中华神经外科疾病研究杂志. 2002;1(004):320-322.
13. MacNally S, Rutherford S, Ramsden R, et al. Trigeminal schwannomas. British Journal of Neurosurgery. 2008;22(6):729-738.
14. Goel A, Muzumdar D. Trigeminal neurinomas: surgical considerations. Cavernous Sinus. 2009:163.
15. Goel A, Shah A, Muzumdar D, et al. Trigeminal neurinomas with extracranial extension: analysis of 28 surgically treated cases. Journal of neurosurgery. 2009:1-6.
16. Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52(4):783.
17. Machado AG, Aguiar PH, Marino Jr R. Pathological laughter in a patient with trigeminal neurinoma. Arquivos de Neuro-Psiquiatria. 2002;60:1000-1002.
18. Jagetia A, Pratap Kumar N, Singh D, et al. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurgical review. 2006;29(4):348-352.
19.孟莉.颅内三叉神经鞘瘤的CT及MRI诊断.中国耳鼻咽喉颅底外科杂志. 2007;13(003):203-205.
20.王卫斌,林志春,曲华丽等.颅内三叉神经鞘瘤的MRI诊断及鉴别诊断.医学影像学杂志. 2008;18(012):1359-1361.
21.江桂华,田军章,陈喜兰等.海绵窦海绵状血管瘤及其影像学特点.国外医学:脑血管疾病分册. 2005;13(012):907-910.
22.段刚,彭旭红.中颅窝区脑外肿瘤的MRI表现. CHINESE JOURNALOF NEUROMEDICINE. 2009;8(7):86-89.
23.刘志雄,袁贤瑞.三叉神经鞘瘤的诊断与手术治疗.中国耳鼻咽喉颅底外科杂志. 2002;8(004):217-219.
24.刘国江,伍小红,瞿浩.以多发性硬化为表现的三叉神经鞘瘤1例.疑难病杂志. 2008;7(005):305-306.
25.袁进国,于明克,王子文.桥小脑角区血管周细胞瘤误诊为三叉神经鞘瘤l例.中国肿瘤临床与康复. 2007;8(3):23.
26. Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. Journal of Neurosurgery: Pediatrics. 2002;96(3):35-38.
27.周良辅,毛颖.哑铃状三叉神经鞘瘤的外科治疗.中华外科杂志. 2002;40(002):81-83.
28.刘志雄,袁贤瑞,刘景平等.中颅窝底硬膜外入路显微手术切除三叉神经鞘瘤.湖南医科大学学报. 2003;28(003):295-297.
29.徐淑军,李新钢,周茂德等.三叉神经鞘瘤的手术入路探讨.中华神经外科杂志. 2005;21(009):539-541.
30.潘力雄,刘运生,陈忠平等.扩大翼点入路切除前中颅底病灶的临床体会.中华神经医学杂志. 2005;4(010):1032-1033.
31.江涛,于春江.听神经瘤枕下乙状窦后开颅技术的改进临床研究.中国微侵袭神经外科杂志. 2001;6(001):19-21.
32.徐启武,车晓明.中,后颅窝型三叉神经经鞘瘤的诊断与治疗.中国神经精神疾病杂志. 2002;28(006):443-5.
33.徐启武.颅底手术彩色图谱:天津,天津科学技术出版社; 2000:305-308.
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51. Asari S, Tsuchida S, Fujiwara A, et al. Trigeminal neurinoma presenting with intratumoral hemorrhage: report of two cases. Clinical neurology and neurosurgery. 1992;94(3):219-224.
52. Ooi G, Peh W, Fung C. Acute haemorrhagic presentation of trigeminal neuroma. British journal of radiology. 1996;69(820):363-365.
53. Kubota T, Hayashi M, Yamamoto S. Subarachnoid hemorrhage due to trigeminal neurinoma. Surgical neurology. 1981;16(2):157-160.
54. Nager G. Neurinomas of the trigeminal nerve***. American journal of otolaryngology. 1984;5(5):301-333.
55. Yamada K, Ohta T, Miyamoto T. Bilateral trigeminal schwannomas associated with von Recklinghausen disease. American Journal of Neuroradiology. 1992;13(1):299.
56.周良辅,任力.三叉神经鞘瘤的诊断及治疗.中华神经外科杂志. 1997;13(004):201-204.
57. Park C, Jung H, Kim J, et al. The selection of the optimal therapeuticstrategy for petroclival meningiomas. Surgical neurology. 2006;66(2):160-165.
58.邵君飞,张岩松,王海秋等.鞍旁硬膜间腔岩尖入路治疗三叉神经鞘瘤.临床神经外科杂志. 2007;4(4):29-43.
59. Guinto G, Abello J, Molina A, et al. Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space. Neurosurgery. 1999;45(6):1385.
60.尹森.前,中颅窝颅底沟通肿瘤的联合手术治疗临床分析:山东大学, 2009.
61. Yasui T, Hakuba A, Kim S, et al. Trigeminal neurinomas: operative approach in eight cases. Journal of neurosurgery. 1989;71(4):506-11.
2. Samii M, Migliori M, Tatagiba M etc. Surgical treatment of trigeminal schwannomas. Journal of Neurosurgery: Pediatrics. 1995;82(5):37-41.
3. Taha J, Tew Jr J, van Loveren H etc. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. Journal of neurosurgery. 1995;82(5):719-725.
4. Frazier C. An operable tumor involving the Gasserian ganglion. The Journal of Nervous and Mental Disease. 1919;50(1):74.
5. Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clinical neurosurgery. 1953;1:11.
6. Schisano G, Olivecrona H. Neurinomas of the Gasserian ganglion and trigeminal root. Journal of neurosurgery. 1960;17:306.
7. Konovalov A, Spallone A, Mukhamedjanov D etc. Trigeminal neurinomas a series of 111 surgical cases from a single institution. Acta neurochirurgica. 1996;138(9):1027-1035.
8. Sarma S, Sekhar L, Schessel D. Nonvestibular schwannomas of the·brain: a 7-year experience. Neurosurgery. 2002;50(3):437.
9. Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. Journal of neurosurgery. 1999;91(2):202-211.
10. Gwak H, Hwang S, Paek S etc. Long-term outcome of trigeminal neurinomas with modified classification focusing on petrous erosion* 1. Surgical neurology. 2003;60(1):39-48.
11. Dolenc V. Frontotemporal epidural approach to trigeminal neurinomas. Actaneurochirurgica. 1994;130(1):55-65.
12.徐启武,车晓明.三叉神经鞘瘤的诊断与手术入路选择.中华神经外科疾病研究杂志. 2002;1(004):320-322.
13. MacNally S, Rutherford S, Ramsden R etc. Trigeminal schwannomas. British Journal of Neurosurgery. 2008;22(6):729-738.
14. Goel A, Muzumdar D. Trigeminal neurinomas: surgical considerations. Cavernous Sinus. 2009:163.
15. Goel A, Shah A, Muzumdar D etc. Trigeminal neurinomas with extracranial extension: analysis of 28 surgically treated cases. Journal of neurosurgery. 2009:1-6.
16. Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52(4):783.
17. Machado AG, Aguiar PH, Marino Jr R. Pathological laughter in a patient with trigeminal neurinoma. Arquivos de Neuro-Psiquiatria. 2002;60:1000-1002.
18. Jagetia A, Pratap Kumar N, Singh D etc. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurgical review. 2006;29(4):348-352.
19.孟莉.颅内三叉神经鞘瘤的CT及MRI诊断.中国耳鼻咽喉颅底外科杂志. 2007;13(003):203-205.
20.王卫斌,林志春,曲华丽等.颅内三叉神经鞘瘤的MRI诊断及鉴别诊断.医学影像学杂志. 2008;18(012):1359-1361.
21.江桂华,田军章,陈喜兰等.海绵窦海绵状血管瘤及其影像学特点.国外医学:脑血管疾病分册. 2005;13(012):907-910.
22.段刚,彭旭红.中颅窝区脑外肿瘤的MRI表现. CHINESE JOURNAL OF NEUROMEDICINE. 2009;8(7):86-89.
23.刘志雄,袁贤瑞.三叉神经鞘瘤的诊断与手术治疗.中国耳鼻咽喉颅底外科杂志. 2002;8(004):217-219.
24.刘国江,伍小红,瞿浩.以多发性硬化为表现的三叉神经鞘瘤1例.疑难病杂志. 2008;7(005):305-306.
25.袁进国,于明克,王子文.桥小脑角区血管周细胞瘤误诊为三叉神经鞘瘤l例.中国肿瘤临床与康复. 2007;8(3):23.
26. Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. Journal of Neurosurgery: Pediatrics. 2002;96(3):35-38.
27.周良辅,毛颖.哑铃状三叉神经鞘瘤的外科治疗.中华外科杂志. 2002;40(002):81-83.
28.刘志雄,袁贤瑞,刘景平等.中颅窝底硬膜外入路显微手术切除三叉神经鞘瘤.湖南医科大学学报. 2003;28(003):295-297.
29.徐淑军,李新钢,周茂德等.三叉神经鞘瘤的手术入路探讨.中华神经外科杂志. 2005;21(009):539-541.
30.潘力雄,刘运生,陈忠平等.扩大翼点入路切除前中颅底病灶的临床体会.中华神经医学杂志. 2005;4(010):1032-1033.
31.江涛,于春江.听神经瘤枕下乙状窦后开颅技术的改进临床研究.中国微侵袭神经外科杂志. 2001;6(001):19-21.
32.徐启武,车晓明.中,后颅窝型三叉神经经鞘瘤的诊断与治疗.中国神经精神疾病杂志. 2002;28(006):443-445.
33.徐启武.颅底手术彩色图谱:天津,天津科学技术出版社; 2000:305-308.
1. Dixon J. Tumor of gassserian ganglion. Med Clin Trans London. 1846;29:131.
2. Samii M, Migliori M, Tatagiba M, et al. Surgical treatment of trigeminal schwannomas. Journal of Neurosurgery: Pediatrics. 1995;82(5):37-41.
3. Taha J, Tew Jr J, van Loveren H, et al. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. Journal of neurosurgery. 1995;82(5):719-725.
4. Frazier C. An operable tumor involving the Gasserian ganglion. The Journal of Nervous and Mental Disease. 1919;50(1):74.
5. Jefferson G. The trigeminal neurinomas with some remarks on malignant invasion of the gasserian ganglion. Clinical neurosurgery. 1953;1:11.
6. Schisano G, Olivecrona H. Neurinomas of the Gasserian ganglion and trigeminal root. Journal of neurosurgery. 1960;17:306.
7. Konovalov A, Spallone A, Mukhamedjanov D, et al. Trigeminal neurinomas a series of 111 surgical cases from a single institution. Acta neurochirurgica. 1996;138(9):1027-1035.
8. Sarma S, Sekhar L, Schessel D. Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery. 2002;50(3):437.
9. Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. Journal of neurosurgery. 1999;91(2):202-211.
10. Gwak H, Hwang S, Paek S, et al. Long-term outcome of trigeminal neurinomas with modified classification focusing on petrous erosion* 1.Surgical neurology. 2003;60(1):39-48.
11. Dolenc V. Frontotemporal epidural approach to trigeminal neurinomas. Acta neurochirurgica. 1994;130(1):55-65.
12.徐启武,车晓明.三叉神经鞘瘤的诊断与手术入路选择.中华神经外科疾病研究杂志. 2002;1(004):320-322.
13. MacNally S, Rutherford S, Ramsden R, et al. Trigeminal schwannomas. British Journal of Neurosurgery. 2008;22(6):729-738.
14. Goel A, Muzumdar D. Trigeminal neurinomas: surgical considerations. Cavernous Sinus. 2009:163.
15. Goel A, Shah A, Muzumdar D, et al. Trigeminal neurinomas with extracranial extension: analysis of 28 surgically treated cases. Journal of neurosurgery. 2009:1-6.
16. Goel A, Muzumdar D, Raman C. Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery. 2003;52(4):783.
17. Machado AG, Aguiar PH, Marino Jr R. Pathological laughter in a patient with trigeminal neurinoma. Arquivos de Neuro-Psiquiatria. 2002;60:1000-1002.
18. Jagetia A, Pratap Kumar N, Singh D, et al. Pathological laughter in trigeminal schwannoma: case report and review of the literature. Neurosurgical review. 2006;29(4):348-352.
19.孟莉.颅内三叉神经鞘瘤的CT及MRI诊断.中国耳鼻咽喉颅底外科杂志. 2007;13(003):203-205.
20.王卫斌,林志春,曲华丽等.颅内三叉神经鞘瘤的MRI诊断及鉴别诊断.医学影像学杂志. 2008;18(012):1359-1361.
21.江桂华,田军章,陈喜兰等.海绵窦海绵状血管瘤及其影像学特点.国外医学:脑血管疾病分册. 2005;13(012):907-910.
22.段刚,彭旭红.中颅窝区脑外肿瘤的MRI表现. CHINESE JOURNALOF NEUROMEDICINE. 2009;8(7):86-89.
23.刘志雄,袁贤瑞.三叉神经鞘瘤的诊断与手术治疗.中国耳鼻咽喉颅底外科杂志. 2002;8(004):217-219.
24.刘国江,伍小红,瞿浩.以多发性硬化为表现的三叉神经鞘瘤1例.疑难病杂志. 2008;7(005):305-306.
25.袁进国,于明克,王子文.桥小脑角区血管周细胞瘤误诊为三叉神经鞘瘤l例.中国肿瘤临床与康复. 2007;8(3):23.
26. Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. Journal of Neurosurgery: Pediatrics. 2002;96(3):35-38.
27.周良辅,毛颖.哑铃状三叉神经鞘瘤的外科治疗.中华外科杂志. 2002;40(002):81-83.
28.刘志雄,袁贤瑞,刘景平等.中颅窝底硬膜外入路显微手术切除三叉神经鞘瘤.湖南医科大学学报. 2003;28(003):295-297.
29.徐淑军,李新钢,周茂德等.三叉神经鞘瘤的手术入路探讨.中华神经外科杂志. 2005;21(009):539-541.
30.潘力雄,刘运生,陈忠平等.扩大翼点入路切除前中颅底病灶的临床体会.中华神经医学杂志. 2005;4(010):1032-1033.
31.江涛,于春江.听神经瘤枕下乙状窦后开颅技术的改进临床研究.中国微侵袭神经外科杂志. 2001;6(001):19-21.
32.徐启武,车晓明.中,后颅窝型三叉神经经鞘瘤的诊断与治疗.中国神经精神疾病杂志. 2002;28(006):443-5.
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51. Asari S, Tsuchida S, Fujiwara A, et al. Trigeminal neurinoma presenting with intratumoral hemorrhage: report of two cases. Clinical neurology and neurosurgery. 1992;94(3):219-224.
52. Ooi G, Peh W, Fung C. Acute haemorrhagic presentation of trigeminal neuroma. British journal of radiology. 1996;69(820):363-365.
53. Kubota T, Hayashi M, Yamamoto S. Subarachnoid hemorrhage due to trigeminal neurinoma. Surgical neurology. 1981;16(2):157-160.
54. Nager G. Neurinomas of the trigeminal nerve***. American journal of otolaryngology. 1984;5(5):301-333.
55. Yamada K, Ohta T, Miyamoto T. Bilateral trigeminal schwannomas associated with von Recklinghausen disease. American Journal of Neuroradiology. 1992;13(1):299.
56.周良辅,任力.三叉神经鞘瘤的诊断及治疗.中华神经外科杂志. 1997;13(004):201-204.
57. Park C, Jung H, Kim J, et al. The selection of the optimal therapeuticstrategy for petroclival meningiomas. Surgical neurology. 2006;66(2):160-165.
58.邵君飞,张岩松,王海秋等.鞍旁硬膜间腔岩尖入路治疗三叉神经鞘瘤.临床神经外科杂志. 2007;4(4):29-43.
59. Guinto G, Abello J, Molina A, et al. Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space. Neurosurgery. 1999;45(6):1385.
60.尹森.前,中颅窝颅底沟通肿瘤的联合手术治疗临床分析:山东大学, 2009.
61. Yasui T, Hakuba A, Kim S, et al. Trigeminal neurinomas: operative approach in eight cases. Journal of neurosurgery. 1989;71(4):506-11.