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目的总结72例以三叉神经痛为主要表现的胆脂瘤的临床特点、手术入路与技巧,并提出胆脂瘤切除分级标准。方法回顾性总结了以三叉神经痛为主要表现的胆脂瘤患者的临床表现、肿瘤生长部位与大小、手术入路与技巧、结果和术后并发症等。结果术后三叉神经痛均消失。全切除38例,次全切除25例,大部切除5例,部分切除4例。无手术死亡。术后19例症状体征完全恢复。术后并发症以暂时性颅神经功能障碍最多见,无菌性脑膜炎7例,治疗后痊愈;外展神经损伤1例未恢复;复发5例。结论胆脂瘤导致的三叉神经痛临床表现多不很典型,术前确诊率较低。常用的手术入路为枕下乙状窦后入路和颞枕枕下乙状窦后幕上下联合入路。胆脂瘤切除程度可分为全切除、次全切除、大部切除和部分切除4级。肿瘤切除后三叉神经痛即停止,无需特殊处理。
Objective To summarize the clinical features, surgical approaches and techniques of 72 cholesteatoma patients with trigeminal neuralgia as main manifestations and to propose the cholesteatoma resection grading standards. Methods The clinical manifestations, site and size of tumor growth, surgical approaches and techniques, results and postoperative complications of cholesteatoma patients with trigeminal neuralgia were retrospectively reviewed. Results Trigeminal neuralgia disappeared after operation. Total resection in 38 cases, subtotal resection in 25 cases, partial resection in 5 cases, partial resection in 4 cases. No surgery died. Postoperative 19 patients with signs and symptoms completely restored. Postoperative complications of transient cranial nerve dysfunction is the most common, 7 cases of aseptic meningitis, healed after treatment; 1 case of abducens nerve injury did not recover; 5 cases of recurrent. Conclusion The clinical manifestations of trigeminal neuralgia caused by cholesteatoma are not typical, the preoperative diagnosis rate is low. The commonly used surgical approach is the suboccipital sigmoid sinus posterior approach and temporal occipital submandibular sinus posterior curtain joint approach. The degree of cholesteatoma resection can be divided into total resection, subtotal resection, most resection and partial resection level 4. After the tumor excision trigeminal neuralgia that stopped, without special treatment.