[1]王强,王汉东,潘灏,等.巨大海绵窦海绵状血管瘤的硬膜内入路显微外科治疗[J].临床神经外科杂志,2020,17(01):42-51.
 WANG Qiang,WANG Han-dong,PAN Hao,et al.Intradural transcavernous surgical mangement of giant cavernous sinus hemangiomas[J].Journal of Clinical Neurosurgery,2020,17(01):42-51.
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巨大海绵窦海绵状血管瘤的硬膜内入路显微外科治疗()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
17
期数:
2020年01期
页码:
42-51
栏目:
颅内肿瘤专题
出版日期:
2020-02-15

文章信息/Info

Title:
Intradural transcavernous surgical mangement of giant cavernous sinus hemangiomas
文章编号:
202001010
作者:
王强王汉东潘灏孙康健潘云曦
210002 南京,解放军东部战区总医院神经外科
Author(s):
WANG Qiang WANG Han-dong PAN Hao et al.
Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
关键词:
海绵窦海绵状血管瘤外科手术硬膜内入路
Keywords:
cavernous sinus cavernous hemangioma surgery intradural approach
分类号:
R651.1+2
文献标志码:
A
摘要:
目的探讨巨大海绵窦海绵状血管瘤(cavernous sinus cavernous hemangiomas,CSHs)的临床特征及显微外科治疗方法,为CSHs的治疗提供临床经验。方法回顾性分析2009年1月—2018年12月解放军东部战区总医院神经外科收治的15例CSHs患者的临床及随访资料;分析患者的临床表现、颅神经受累情况、手术方式、术后并发症及随访结果。结果15例CSHs患者占同期收治的颅内海绵状血管瘤(CHs)患者的5.6%。临床表现为头痛者11例、视神经损害者5例、动眼神经损害者6例、面部感觉异常者2例、肢体无力者1例。15例患者通过扩大翼点、翼点或颞前小切口入路经硬膜内切除血管瘤,均完整切除;无死亡病例。10例患者术后出现同侧Ⅲ、Ⅳ、Ⅴ及Ⅵ神经部分麻痹。术后获得随访的患者9例,随访时间5~117个月,平均48.9个月,均无肿瘤复发表现;其中4例患者遗留长期海绵窦颅神经功能障碍。结论CSHs多具备特征性影像学表现,术前多可明确诊断。经硬膜内入路手术切除是治疗巨大CSHs的有效方法,术中应尽量按界限整块切除,以减少出血。海绵窦内神经功能的保留仍是目前巨大CSHs手术治疗的难点。
Abstract:
To explore the clinical features and microsurgical treatment of giant cavernous sinus cavernous hemangiomas(CSHs). MethodsThe clinical and follow-up data of 15 patients with CSHs admitted to Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University from January 2009 to December 2018 were analyzed retrospectively. The clinical manifestations, cranial nerve involvement, surgery methods, postoperative complications and follow-up results were analyzed. Results15 cases of CSHs accounted for 5.6% of intracranial cavernous hemangioma at department of neurosurgery, in the same period. The clinical manifestations were mostly headache in 11 cases, decreased visual acuity in 5, oculomotor nerve damage disfunction in 6, facial numbness in 2 and limb weakness in 1. Intradural resection was performed via the pterion or extended pterion or temporal small arc incision approach. Complete resection was performed in all patients. No death occurred. Ten patients developed partial ipsilateral Ⅲ, Ⅳ, Ⅴ, and Ⅵ nerve palsy after surgery. 9 cases were followed up with mean follow-up time of 48.9 months(5-117 months). None had tumor recurrence, and 4 cases had long-term cavernous sinus cranial nerve dysfunction. ConclusionsCSHs has characteristic imaging findings and almost can be definitively diagnosed before operation. Microsurgical total resection via intradural approach is an effective method for the treatment of giant CSHs. En bloc resection should be performed along the border in order to reduce bleeding. The preservation of nerve function in the cavernous sinus is still a difficult point in the surgical treatment of giant CSHs.

相似文献/References:

[1]惠卫宁.鞍区海绵状血管瘤误诊为侵袭性垂体瘤一例并文献复习[J].临床神经外科杂志,2014,(02):116.
[2]王清,严正村,孙俊,等.神经内镜下经鼻扩大入路至中颅底的解剖学研究[J].临床神经外科杂志,2016,(02):93.
 WANG Qing,YAN Zheng-cun,SUN Jun,et al.Anatomic study on etended endoscopic endonasal approach to middle skull base[J].Journal of Clinical Neurosurgery,2016,(01):93.
[3]熊方令,刘保华,高明明,等.颅骨海绵状血管瘤手术治疗临床分析[J].临床神经外科杂志,2019,16(1):77.[doi:10.3969/j.issn.1672-7770.2019.01.018]
 XIONG Fang-ling,LIU Bao-hua,GAO Ming-ming,et al.Clinical analysis on treatment of cranial bone cavernous hemangioma[J].Journal of Clinical Neurosurgery,2019,16(01):77.[doi:10.3969/j.issn.1672-7770.2019.01.018]

备注/Memo

备注/Memo:
【作者简介】王汉东,东部战区总医院(原南京军区南京总医院)神经外科主任,全军神经外科研究所所长,医学博士学位,主任医师,教授,博导。现任中华医学会神经外科分会委员,中国医师协会神经外科分会委员,中国神经科学学会神经肿瘤分会常委,江苏省神经科学学会副理事长兼神经肿瘤与神经创伤分会主任委员,曾任南京军区神经外科专业委员会主任委员、江苏省医学会神经外科分会主任委员;担任《中华神经外科杂志》《中华外科杂志》《中华实验外科杂志》《Neurosurgery》中文版及《Chinese Neurosurgical Journal》等十余种医学期刊的编委,担任《临床神经外科杂志》和《医学研究所学报》副主编。从医37年,积累7000余台手术经验,技术精湛,擅长手术治疗疑难重症,尤其在诊治脑深部肿瘤、颅底肿瘤和脑干肿瘤这些高难度肿瘤以及复杂的脑动脉瘤和脑血管畸形等方面造诣深厚。连续多年为“中国名医百强榜”上榜名医。以第一或通信作者发表学术论文200余篇,其中SCI论文100余篇,主编《神经外科手术彩色图解》,主译《AL-Mefty脑膜瘤》,获省部级及军队科技进步奖多项。培养博士研究生及博士后43名,硕士研究生37名。
更新日期/Last Update: 2020-02-19