颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤

doi:10.3969/j.issn.1672-6731.2020.12.011

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (12): 1092-1098. doi: 10.3969/j.issn.1672-6731.2020.12.011

2 颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤

孙思, 康军, 赵尚峰, 邱锷, 李永, 史继桐, 马建民

100730 首都医科大学附属北京同仁医院神经外科

收稿日期:2020-12-08 出版日期:2020-12-25 发布日期:2020-12-31
通讯作者: 康军,Email:junkang2015@163.com
基金资助:
北京市科委首都市民健康培育项目（项目编号：Z151100003915153）

Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach

SUN Si, KANG Jun, ZHAO Shang-feng, QIU E, LI Yong, SHI Ji-tong, MA Jian-min

Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2020-12-08 Online:2020-12-25 Published:2020-12-31
Supported by:
This study was supported by Beijing Science and Technology Commission Capital Citizen Health Training Program (No. Z151100003915153).

摘要/Abstract

摘要：

目的探讨经颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤的疗效和安全性。方法与结果 纳入2013年1月至2019年1月经颅眶联合入路即改良Dolenc入路联合眶上入路手术切除海绵窦-眼眶沟通三叉神经鞘瘤患者共23例，其中肿瘤全切除20例、近全切除3例。13例术前即存在视力下降患者中7例视力进一步下降；5例术前眼动障碍和（或）上睑下垂患者中3例残留眼动障碍，另有11例术后新发眼动障碍。23例中无一例发生脑脊液漏、颅内血肿或颅内感染，无死亡或肿瘤复发病例。结论由于海绵窦-眼眶沟通三叉神经鞘瘤部位与周围毗邻解剖结构关系特殊，术后易出现视力下降和眼动障碍等并发症，采用经颅眶联合入路手术，全切除率较高、手术相关并发症发生率相对较低。

关键词: 三叉神经, 神经鞘瘤, 海绵窦, 眼眶, 显微外科手术, 手术后并发症

Abstract:

Objective To investigate the efficacy and safety of cranio-orbital approach for the removal of cavernous sinus-orbital communication trigeminal schwannomas. Methods and Results A total of 23 patients with cavernous sinus-orbital communication trigeminal schwannoma were included from January 2013 to January 2019, the combined cranio-orbital approach (modified Dolenc approach combined with supraorbital approach) was used for surgical resection of tumors. Total tumor resection was performed in 20 cases and nearly total resection in 3 cases. Thirteen patients with preoperative visual loss, 7 of them further decreased visual acuity; 5 cases with preoperative eye movement disorder and/or ptosis, 3 cases with residual eye movement disorder, and 11 cases appeared new eye movement disorders after surgery. None of the 23 cases occurred cerebrospinal fluid leakage, intracranial hematoma or intracranial infection occurred, no death and no tumor recurrence case. Conclusions Cavernous sinus-orbital communication trigeminal schwannoma, due to the special tumor occurrence site and surrounding anatomical structure, was easy to cause complications such as visual loss and eye movement disorder during operation. The combined cranio-orbital approach was used, it may increase the total resection rate, and also show relatively low surgical complications rate.

Key words: Trigeminal nerve, Neurilemmoma, Cavernous sinus, Orbit, Microsurgery, Postoperative complications

孙思, 康军, 赵尚峰, 邱锷, 李永, 史继桐, 马建民. 颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤[J]. 中国现代神经疾病杂志, 2020, 20(12): 1092-1098.

SUN Si, KANG Jun, ZHAO Shang-feng, QIU E, LI Yong, SHI Ji-tong, MA Jian-min. Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1092-1098.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I12/1092

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Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach

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2 颅眶联合入路切除海绵窦-眼眶沟通三叉神经鞘瘤

Resection of trigeminal schwannomas in cavernous sinus-orbital region via epidural cranio-orbital approach

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