Neskey David M, Hatoum Georges, Modh Rishi, Civantos Francisco, Telischi Fred F, Angeli Simon I, Weed Donald, Sargi Zoukaa
Skull Base. 2011 May;21(3):171-6. doi: 10.1055/s-0031-1275251.
We reviewed the postoperative functional outcome following surgical resection of paragangliomas in patients with and without preoperative cranial nerve dysfunction. Patients who underwent surgical resections of head and neck paragangliomas were reviewed with functional outcomes defined as feeding tube and/or tracheostomy dependence, need for vocal cord medialization, and incidence of cerebral vascular accidents as primary end points. Secondary end points included pre- and postoperative function of lower cranial nerves and the impact of this dysfunction on long-term functional status. Sixty-one patients were identified: 27 with carotid paraganglioma (CP), 21 with jugular paraganglioma (JP), 8 with tympanic paragangliomas, 4 with vagal paragangliomas (VPs), and 1 with aortopulmonary paraganglioma. Following resection, 8 patients were feeding tube dependent, 14 patients required vocal cord medialization, 2 patients suffered strokes, but no patients required tracheostomy tubes. Twenty percent of patients (4/20) with JP and postoperative cranial neuropathies were feeding tube dependent, and 80% of patients (4/5) with CP and postoperative cranial nerve dysfunction were feeding tube dependent. Cranial nerve deficits were more common in patients with JP relative to those with CP. However, when cranial nerve dysfunction was present, our patients with CP had a higher incidence of temporary feeding tube dependence. Overall, 98% of patients were able to resume oral nutrition.
我们回顾了术前有无颅神经功能障碍的患者在副神经节瘤手术切除后的术后功能结局。对接受头颈部副神经节瘤手术切除的患者进行了回顾,将功能结局定义为鼻饲管和/或气管造口依赖、声带内移的需求以及脑血管意外的发生率作为主要终点。次要终点包括术前和术后下颅神经功能以及这种功能障碍对长期功能状态的影响。共确定了61例患者:27例为颈动脉体瘤(CP),21例为颈静脉球瘤(JP),8例为鼓室副神经节瘤,4例为迷走神经副神经节瘤(VP),1例为主动脉肺副神经节瘤。切除术后,8例患者依赖鼻饲管,14例患者需要声带内移,2例患者发生中风,但无一例患者需要气管造口管。20%(4/20)的JP患者和术后颅神经病变患者依赖鼻饲管,80%(4/5)的CP患者和术后颅神经功能障碍患者依赖鼻饲管。相对于CP患者,JP患者的颅神经缺损更为常见。然而,当存在颅神经功能障碍时,我们的CP患者临时依赖鼻饲管的发生率更高。总体而言,98%的患者能够恢复经口营养。