颈静脉孔区脊索瘤16例临床分析.pdf

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1、·996·中华神外科杂志2013年10月第29卷第1O期ChinJNeurosurg，October2013，V0】．29，No．10．脑月中瘤．颈静脉孔区脊索瘤16例临床分析田凯兵王亮郝淑煜李达王科吴震张力伟张俊延【摘要】目的探讨颈静脉孔区脊索瘤的临床特点和手术疗效。方法回顾性分析16例颈静脉孔区脊索瘤患者的临床资料并进行随访。结果16例颈静脉孔区脊索瘤患者中，主要表现为后组脑神经麻痹症状(12例)。手术主要采用枕下远外侧经髁入路(10例)，肿瘤全切5例，次全切10例，大部切除1例，病理软骨型为主(11例)，术后3例接受放射治疗，随访到的l3例患者有症状者仍以后组脑神经功能障碍为主(7

2、例)。结论颈静脉孑L区脊索瘤患者临床症状以后组脑神经麻痹症状为主，病理类型以软骨型多见，选择合适的手术入路，术中注意脑神经功能的保护是手术成功的关键，术后根据情况辅以放疗可获得良好的结果。【关键词】脊索瘤；颈静脉孔区；脑神经麻痹Chordomainthejugularforamenarea：areviewof16casesTIANKai—bing，WANGLiang，HAOShu—yu，LIDa，WANGKe，WUZhen，ZHANGLi—wei，ZHANGJun—ring．DepartmentofNeurosurgery，BeijingTiantanHospital，CapitalMe

3、dicalUniversity，Beng100050，ChinaCorrespondingauthor：ZHANGJun—ting，Email：zhangjunting2003@yahoo．eol?kcn【Abstract】ObjectiveToanalysistheclinicalcharacteristics，surgicaltreatmentandoutcomeofchordomairitheiugularforamenarea．MethodsTheauthorretrospectivelystudieddatafrom16patientswithchordomaintheiugu

4、larforamenareawhohadundergonesurgeriesinthedepartmentofskullbaseandbrainstemofBeijingTiantanHospitalbetweenJanuary2006andJune2011，andfollow—upwasperformedthroughrecheckinout—patientdepartment，telephoneandletter．ResultsThereare8femalesand8malesinthisgroupandallofthemunderwentsurgicalprocedures．The

5、meanageis39．year．oldandthemeansymptomatichistorytimewas18．3months．Themainclinicalpresentationisparalysisofthelowercranialnerves(Ⅸ，XandXI，12cases)，6patientsalsosuferedfromdeficitsincranialnerveVi，otherpresentationsaredeficitsineyesight(4cases)，ataxia(3cases)，numbnessoflimbs(2cases)，facialparalysis

6、(2cases)anddeficitsofabducentnerve(1case)．Farlateralapproachwasusedin10cases，retrosigmoidsuboccipitalapproachwasusedin2cases，infratemporaltrans-tentoriumofcerebellumapproachin2casesandexpandedmiddlecranialfossaapproachin2cases．Grosstotalremovalwasachivevdin5cases．subtotalremovalin10casesandpartia

7、lresection1case．Thepathologictypeof5casesinthisgroupistypicalchordoma，andother11casesarechondroidchordomz．Follow-uprevealedobviousimprovementin5cases，permanentparalysisofthelowercranialnervesin7casesandfacialparalysisi