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目的探讨经中颅底硬膜间入路切除中后颅窝哑铃型三叉神经鞘瘤的手术适应症及治疗效果。方法回顾性分析2009年10月至2014年11月间南京医科大学附属脑科医院神经外科采用经中颅底硬膜间入路切除中后颅窝哑铃型三叉神经鞘瘤7例患者的临床及影像资料、手术疗效和术后并发症情况。结果 7例患者中Mp型5例、MP型2例。7例患者术后第1d复查MRI显示肿瘤均全切,无手术死亡者;术后脑神经功能障碍较术前改善4例,无明显变化3例,无加重和出现新的脑神经麻痹;1例患者出现皮下积液和颅内感染,经腰穿置管脑脊液引流和抗生素治疗痊愈;1例出现颞肌萎缩。术后7例患者均长期随访,随访时间12~60个月,无1例患者复发。结论中颅底硬膜间入路手术是切除Mp型和部分MP型三叉神经鞘瘤的一种有效治疗方法,主要在硬膜间进行手术操作,有利于脑组织、脑神经及血管的保护,手术损伤小、反应小、并发症少。
Objective To investigate the surgical indications and therapeutic effects of removing the middle posterior fossa dumbbell-type trigeminal schwannoma through the midcourse of the dura mater. Methods The clinical data of 7 patients with middle-posterior cranial dumbbell-type trigeminal schwannoma resected through the mid-skull base dura mater were retrospectively analyzed from October 2009 to November 2014 in Department of Neurosurgery, Affiliated Brain Hospital, Nanjing Medical University. Video data, surgical efficacy and postoperative complications. Results Among the 7 patients, 5 were Mp type and 2 were MP type. Seven patients were examined by MRI on the first day after operation, and all the tumors were completely resected without any surgical death. The postoperative neurological dysfunction was improved in 4 cases compared with that before operation, with no obvious change in 3 cases, without aggravation and new neuroparalysis 1; Cases of patients with subcutaneous fluid and intracranial infection, drainage through the lumbar canal cerebrospinal fluid drainage and antibiotic therapy recovered; 1 case of temporal muscle atrophy. All the 7 patients were followed up for a long period of time from 12 to 60 months without any recurrence. Conclusion The middle cranial basement dura maneuver is an effective treatment for the resection of Mp-type and some MP-type trigeminal schwannoma. The main operation is between the dura mater, which is good for the protection of brain tissue, brain and blood vessels, Small surgical injury, small reaction, fewer complications.