摘要
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 characteristics, the operative approaches and techniques, and to bring forward the removal extent grading of cholesteatoma presenting with trigeminal neuralgia as main manifestation. Methods The clinical manifestation, location and size of the tuner, operative approaches and technique, results and complications of patients with cholesteatoma presenting with trigeminal neuralgia as main manifestation were reviewed, retrospectively. Results Total removal was achieved in 38 cases, approximately total removal in 25 cases, subtotal removal in 5 cases, partial removal in 4 cases and no death. A total of 19 patients got recovery completely. The commonest operative complication was transient cranial nerve palsy. Seven cases developed aseptic meningitis, which was cured by aggressive treatment. The function of abducens nerve, which was damaged in one patient, got not recovery, while 5 cases were recurred. Conclusion The clinical manifestation of trigeminal neuralgia due to cholesteatoma was atypical, and the preoperative confirmed diagnosis rate was relatively low. The operative approaches used frequently were suboccipital retrosigrnoid approach and the combined approach of temporooccipital and suboccipital retrosigmoid approach. The removal extent grading of cholesteatoma was classified as 4 classes： total removal, approximately total removal, geater removal and partial removal. The trigeminal neuralgia was ceased after the removal of the tumor without special treatment.
出处
《中华神经外科疾病研究杂志》
CAS
2007年第2期154-156,共3页
Chinese Journal of Neurosurgical Disease Research
关键词
胆脂瘤
显微外科
三叉神经痛
分级
Cholesteatoma
Microsurgery
Trigeminal neuralgia
Grading
