骑跨中后颅窝哑铃型三叉神经鞘瘤的手术治疗

Surgical treatment of dumbbell trigeminal schwannomas straddling the middle and posterior fossae

摘要:

目的探讨两种入路切除向中后颅窝侵犯的哑铃型三叉神经鞘瘤的手术效果。方法对两种入路治疗的24例中后颅窝哑铃型三叉神经鞘瘤的手术效果进行分析，手术入路选择为幕上额颞开颅为基础辅以硬膜间（Dolenc）入路，幕下开颅枕下乙状窦后开颅为基础的硬膜下入路。结果经幕上组入路共16例，全切7例，次全切9例，经幕下组入路共8例，肿瘤全切6例，次全切2例。结论额颞硬膜间（Dolenc）入路残存率、死亡率较经枕下乙状窦后入路低，但肿瘤全切率及神经功能保留率较幕下入路低。

关键词:哑铃型三叉神经鞘瘤|功能保留|硬膜间入路|硬膜下入路

Abstract:

Abstract:ObjectiveTo investigate the therapeutic effect of two surgical approaches for trigeminal schwannomas straddling the middle and posterior fossae.MethodsClinical data of 24 patients with trigeminal schwannomas simultaneously straddling the middle and posterior fossae were analyzed retrospectively. The adopted surgical approaches included supratentorial frontaltemporal interdural approach with Dolenc technique and infratentorial subdural retrosigmoid approach.ResultsOf all the patients, 16 undergoing tumor resection via supratentorial approach and 8 via infratentorial approach. Total and subtotal tumor resection was achieved in 7 and 9 of the 16 patients undergoing tumor resection via supratentorial approach, while total and subtotal tumor resection was achieved in 5 and 3 of the 8 cases via infratentorial approach.ConclusionAlthough Dolenc approach has low disability rate and fatality rate, retrosigmoid approach may increase the possibility of nerve function preservation and achieve high total resection rate.

Key words:Dumbbell trigeminal schwannoma|Function preservation| Interdural approach|Subdural approach