Microsurgery for hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy

doi:10.3969/j.issn.1672-6731.2020.05.012

Abstract

Abstract:

Objective To investigate and summarize the microsurgical technique for hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy, so as to improve the surgical effect. Methods A total of 17 patients with hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy undergone microsurgical operations from June 2016 to June 2019 were analyzed. The suboccipital retrosigmoid aproach (n=4), infratemporal fossa approach (n=3), transmastoid infralabyrinthine approach (n=3), subtemporal transpetrosal approach (n=3), combined subtemporal and retrosigmoid approach (n=2), and far lateral approach (n=2) were performed according to Samii classification. Results The total resection was achieved in 10 patients, subtotal resection in 4 patients and partial resection in 3 patients. Intraoperative blood loss ranged from 100 ml to 2300 ml, with an average blood loss of 1042 ml. Postoperative clinical symptoms improved in 9 cases. The new-developed and/or worsen lower cranial nerves dysfunction were observed in 5 cases. The new-developed and/or worsen facial paralysis were seen in 6 cases, hearing loss emerged in one case and incision exudation in 2 cases. No intracranial hematoma and death cases were found. Seventeen patients were followed up from 6 months to 3.50 years varied persisted hoarseness or dysphagia were seen in 5 cases. Three cases of recurrence and no death case were observed. Conclusions Intraoperative bleeding can be effectively controlled after preoperative embolization therapy of hypervascular neoplasms in the jugular foramen area. According to the classification of tumors, the surgical approaches are selected individually under the multi-disciplinary cooperation. To remove the tumor safely to great extent can achieve a better therapeutic effect.

Key words: Glomus Jugulare tumor, Embolization, therapeutic, Preoperative period, Microsurgery

摘要：

目的探讨颈静脉孔区富血运肿瘤术前超选择性血管内栓塞再手术切除的治疗方案的有效性和安全性。方法纳入2016年6月至2019年6月共17例颈静脉孔区富血运肿瘤患者，均行术前超选择性肿瘤供血动脉栓塞治疗，再根据Samii分型分别采用经枕下乙状窦后入路（4例）、经颞下窝入路（3例）、经迷路下-乳突入路（3例）、经岩枕入路（3例）、经颞枕联合乙状窦后入路（2例）和经远外侧入路（2例）手术切除肿瘤。结果术中出血量1042 ml。肿瘤全切除10例，次全切除4例，部分切除3例。术后临床症状改善9例，新发和（或）后组脑神经症状加重5例，新发面瘫和（或）面瘫症状加重6例，新发听力丧失1例，伤口渗液2例。无颅内出血、围手术期死亡病例。随访6个月至3.50年，5例仍有不同程度声音嘶哑或饮水呛咳症状。复发3例，无死亡病例。结论颈静脉孔区富血运肿瘤术前栓塞治疗可有效控制术中出血量。依据肿瘤分型，在多学科诊疗模式下个体化选择手术入路，最大程度安全切除肿瘤，可取得较好治疗效果。

关键词: 颈静脉球瘤, 栓塞, 治疗性, 手术前期间, 显微外科手术

YANG Ya-kun, LI Xiu-zhen, LIU Ning, HAN Song, ZHANG Ming-shan, HAN Ming-yang, LIU Jia-chun, YAN Chang-xiang. Microsurgery for hypervascular neoplasms in the jugular foramen area after preoperative embolization therapy[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 441-447.

杨亚坤, 李修珍, 刘宁, 韩松, 张明山, 韩明阳, 刘加春, 闫长祥. 颈静脉孔区富血运肿瘤术前栓塞后的外科治疗[J]. 中国现代神经疾病杂志, 2020, 20(5): 441-447.

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