应用远外侧入路显微神经外科治疗颅颈交界区肿瘤

摘要

目的 探讨远外侧入路显微神经外科在治疗颅颈交界区腹侧及腹外侧肿瘤中的应用.方法 回顾性分析采用远外侧入路显微神经外科治疗的27例颅颈交界区肿瘤患者的手术方法,其中经枕髁后入路5例,经部分枕髁入路8例,经颈静脉结节入路2例,经C1、C2关节面侧方联合经部分枕髁入路12例.采用Karnofskv行为表现量表(KPS)评价临床效果.所有患者术前均行神经系统影像学检查,包括磁共振成像和三维CT血管造影.3例患者为防止术中头部过度后仰导致呼吸心跳停止,术前行预防性气管切开.结果 27例患者中,肿瘤全部切除24例,大部分切除2例,部分切除1例,结果满意.所有患者术后均未出现寰枕关节不稳定症状,术后随访未发现有肿瘤复发.术后患者的KPS评分均提高.手术并发症主要是后组颅神经损伤、皮下积液、脑脊液漏以及脑干或脊髓血管痉挛.结论 远外侧入路是颅颈交界区腹侧及腹外侧肿瘤手术治疗的理想入路.术前神经系统影像学检查对远外侧入路有所帮助,远外侧入路应根据肿瘤病理性质、位置、延伸范围和相关血管受累程度决定骨质切除的多少,显露范围应个体化.%Objective To investigate the application of far lateral approach in tumors located anterior or anterolateral to craniocervieal junction area by microneurosurgery.Methods We retrospective analysis twenty-seven patients clinically that underwent far lateral approach by microneurosurgery,including 5 retrocondylar approach, 8 partial transcondylar approach,2 transtubercular approach and 12 transfacetal and partial transcondylar approach.Clinical results were evaluated by Kamofsky Performance Scale (KPS),all patients underwent preoperative neuroradiological evaluation with magnetic resonance image (MRI)and 3-dimensional computed tomography artery (3DCTA).There are 3 patients who underwent preoperative incision of trachea to prevent of respiration ceases and cardiac arrest because of cephalic excessive hypsokinesis in the process of operation.Results Of all 27 patients,total tumor removal was achieved in 24 patients,subtotal removal was achieved in 2 patients, partial removal was achieved in 1 patient.None of the patients required occipitocervical fusion.Follow-up was showed no recurrence in cases with totally removed of rumor.Postoperative increase of KPS scores were recorded in all patients.The most frequent complications were lower cranial nerve deficit,hypodermic fluidify, CSF leakage and vasospasm of brain stem or spinal cord.Conclusion The far-lateral approach was an ideal approach to tumors located anterior or anterolateral to cranio- cervical junction area.Preoperative neuroradiological evaluations were helpful to the approach,The choice of the approach depends on the pathological peculiarity,position,the extending range and involved in degree of correlating blood vessels.The exposure required for effective surgical treatment should be individualy considerred.