Department of Neurosurgery in Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
Neurosurg Rev. 2020 Oct;43(5):1339-1350. doi: 10.1007/s10143-019-01165-6. Epub 2019 Aug 31.
Complete resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve complications remains difficult even for skilled neurosurgeons. Between November 2011 and November 2017, 31 consecutive patients diagnosed with JFSs underwent a single-stage operation performed by the same neurosurgeon. We retrospectively analyzed clinical characteristics, surgical approaches, treatment outcomes, and follow-up data for these patients. JFSs were classified according to the Samii classification system. A retrosigmoid approach was used to resect type A tumors, while a suboccipital transjugular process (STJP) approach was used to resect type B tumors. Notably, the present study is the first to report the use of a paracondylar-lateral cervical (PCLC) approach for the treatment of type C and D tumors. Type A-D tumors were observed in seven, four, four, and 16 patients, respectively. Gross-total resection was achieved in 29 patients (93.5%). There were no cases of intracranial hematoma, re-operation, tracheotomy, or death. Adjunctive gamma knife treatment was used to manage residual tumors in two patients. Neurological deficits relieved in half of patients at the last follow-up. By reviewing the studies published on PubMed, the approaches gradually be more conservative, rather than widely expose the skull base. Nonetheless, endoscope and stereotactic radiosurgery plays an important role in the management of JFSs. Both tumor removal and neurological function retention can be obtained by choosing individual treatment.
即使对于经验丰富的神经外科医生来说，实现颈静脉孔区神经鞘瘤（JFSs）的完全切除且最小化颅神经并发症仍然具有挑战性。2011 年 11 月至 2017 年 11 月，连续 31 例 JFSs 患者由同一位神经外科医生进行了一期手术。我们回顾性分析了这些患者的临床特征、手术入路、治疗结果和随访数据。JFSs 根据 Samii 分类系统进行分类。采用乙状窦后入路切除 A 型肿瘤，采用枕下经髁突（STJP）入路切除 B 型肿瘤。值得注意的是，本研究首次报道了使用颈突旁-外侧颈椎（PCLC）入路治疗 C 型和 D 型肿瘤。7 例、4 例、4 例和 16 例患者分别观察到 A 型-D 型肿瘤。29 例患者（93.5%）达到大体全切除。无颅内血肿、再次手术、气管切开或死亡病例。2 例患者采用伽玛刀辅助治疗残留肿瘤。在最后一次随访时，有一半患者的神经功能缺损得到缓解。通过回顾 PubMed 上发表的研究，手术入路逐渐变得更加保守，而不是广泛暴露颅底。然而，内窥镜和立体定向放射外科在 JFSs 的治疗中发挥着重要作用。通过选择个体化治疗，可以同时获得肿瘤切除和保留神经功能。
