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目的探讨颈静脉孔及其周围区域肿瘤的最大限度保存功能的手术方法和手术效果。方法回顾分析1999年3月—2005年5月间手术的32例颈静脉孔区肿瘤,根据术前肿瘤性质、大小、位置、听力功能、面神经功能以及后组脑神经功能,分别采用乳突与颈部联合进路(4例)、不移位面神经的颞下窝进路(9例)、移位面神经的颞下窝进路(11例)以及颞下窝进路联合耳蜗进路(8例),分析术后功能保存情况。术中均使用脑神经监护仪,术后均复查 CT 或 MRI。结果 32例颈静脉孔区肿瘤,其中副神经节瘤13例、神经鞘膜瘤10例、脑膜瘤2例、巨细胞瘤2例、软骨肉瘤1例、黏液软骨肉瘤1例、腺样囊性癌1例、胚胎性横纹肌肉瘤1例、胆固醇性肉芽肿1例,随访时间3～60个月。26例肿瘤全切,5例近全切除、1例次全切除。术后死亡2例。5例术后脑脊液漏,2例并发颅内感染,均经保守治疗痊愈;术后1周面神经功能(House-Brackmann 分级)1～2级13例,3～4级12例,5～6级7例;术后3～60个月随访面神经功能1～2级23例,3～4级7例,5～6级2例;术后听力较术前改善4例、不变10例、减退11例,丧失7例;术后9例无后组脑神经症状,11例出现暂时性麻痹,12例出现永久性麻痹但1～3个月后10例代偿,2例未代偿。结论采用不同手术进路切除颈静脉孔区肿瘤可以达到肿瘤切除的同时最大限度保存功能,维持可接受的生活质量,手术技术及熟悉术后并发症的处理为重要因素。
Objective To investigate the surgical methods and surgical results of maximal preservation of tumor in jugular foramen and its surrounding area. Methods Thirty-two cases of jugular foramen tumors were retrospectively analyzed from March 1999 to May 2005. According to the nature, size, location, hearing function, facial nerve function and neurological function of the posterior group of the tumor, Neck joint approach (n = 4), infratemporal fossa approach (n = 9), lateral infratemporal approach (n = 11) and infratemporal fossa approach Cases), analysis of functional preservation. Intraoperative use of cranial nerve monitor, postoperative recheck CT or MRI. Results Thirty-two cases of jugular foramen were identified, including 13 cases of paraganglioma, 10 cases of schwannoma, 2 cases of meningioma, 2 cases of giant cell tumor, 1 case of chondrosarcoma, 1 case of mucinous chondrosarcoma, 1 case of cancer, 1 case of embryonal rhabdomyosarcoma and 1 case of cholesterol granuloma. The follow-up time ranged from 3 to 60 months. Twenty-six patients underwent total resection, five underwent total resection and one underwent total excision. Postoperative death in 2 cases. 5 cases of cerebrospinal fluid leakage and 2 cases of intracranial infection were cured by conservative treatment. One week after operation, there were 13 cases with grade 1 ~ 2 of facial nerve function (House-Brackmann grade), 12 cases with grade 3-4, 5-6 grade 7 cases were followed up from 3 to 60 months after operation, there were 23 cases with facial nerve function grade 1 ~ 2, 7 cases with grade 3 ~ 4 and 2 cases with grade 5 ~ 6. The hearing after operation was improved in 4 cases, unchanged in 10 cases, 11 cases, 7 cases were lost; no neurological symptoms were found in 9 cases after operation, 11 cases had temporary paralysis, 12 cases had permanent paralysis but 10 cases were compensated after 1 ~ 3 months and 2 cases did not compensate. Conclusion The removal of the jugular foramen region by different surgical approach can achieve the maximum tumor preservation while preserving the function, maintaining an acceptable quality of life, and the surgical technique and familiar with the postoperative complications are important factors.