Feng Shi-yu, Bu Bo, Yu Xin-guang, Chen Xiao-lei, Zhang Yan-yang, Zhao Ran, Ren He-cheng, Meng Xiang-hui, Zhou Tao, Zhou Ding-biao
Department of Neurosurgery, Chinese People's Liberation Army General Hospital, 100853 Beijing, China.
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Zhonghua Wai Ke Za Zhi. 2013 Dec;51(12):1099-103.
To investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.
Twenty-three patients (range 26-63 years, mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed. Frontotemporal orbitozygomatic extradural approach was performed in 2 patients. Frontotemporal zygomatic extradural approach was carried out in 21 patients. The first follow-up visit was on the 3rd month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 6 months; otherwise, the patient was followed up every 8-12 months.
The length of hospital stay after surgery was 7-13 days (mean 8.5 days). Two tumors originated from the ophthalmic branch, 2 from the maxillary branch, 5 from the mandibular branch and 14 from the gasserian ganglion. Total resection was achieved in 21 of the 23 patients (91.3%) and subtotal resection in the other 2 patients. All the patients were followed up from 3 months to 4 years. Median follow-up time was 19 months. The most common symptom was facial hypoesthesia, occurring in 18 patients. This symptom improved in 10 patients and worsened in 8 patients after surgery. New postoperative facial hypoesthesia was observed in 2 patients. Facial pain was observed in 3 patients and subsided after surgery. Two patients had loss of hearing, this symptom improved in 1 patient and worsened in 1 patient after surgery. Diplopia was observed in 6 patients. In 1 of these 6 patients, diplopia resulted from palsy of the oculomotor nerve. In the other 5 patients, diplopia resulted from palsy of the abducens nerve. This symptom improved postoperatively in all these 6 patients. New postoperative atrophy of the temporalis muscle was observed in 3 patients. There was no operation-related mortality. Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.
The middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus. This approach produces no further impairment, less complication, and is less likely to injured the trigeminal nerve, abducens nerve, trochlear nerve and internal carotid artery.
探讨硬膜外入路切除累及海绵窦的三叉神经鞘瘤的技术及效果。
回顾性分析23例（年龄26 - 63岁，平均年龄46.2岁）采用中颅窝硬膜外入路治疗的累及海绵窦的三叉神经鞘瘤患者。其中2例行额颞眶颧硬膜外入路，21例行额颞颧硬膜外入路。术后第3个月进行首次随访，若增强磁共振成像（MRI）显示有残留，则每6个月随访1次；否则，每8 - 12个月随访1次。
术后住院时间为7 - 13天（平均8.5天）。2例肿瘤起源于眼支，2例起源于上颌支，5例起源于下颌支，14例起源于三叉神经节。23例患者中，21例（91.3%）实现全切，另外2例次全切。所有患者随访3个月至4年。中位随访时间为19个月。最常见的症状是面部感觉减退，18例患者出现该症状。术后10例患者症状改善，8例患者症状加重。术后新出现面部感觉减退2例。3例患者出现面部疼痛，术后缓解。2例患者听力丧失，术后1例患者症状改善，1例患者症状加重。6例患者出现复视。其中1例患者复视是由动眼神经麻痹所致，另外5例患者复视是由展神经麻痹所致。这6例患者术后该症状均改善。术后新出现颞肌萎缩3例。无手术相关死亡。仅1例患者在24个月后出现肿瘤复发，接受伽玛刀治疗。
中颅窝硬膜外入路可能是切除累及海绵窦的三叉神经鞘瘤的理想选择。该入路不会造成进一步损伤，并发症较少，且较少损伤三叉神经、展神经、滑车神经及颈内动脉。
