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[颈静脉孔副神经节瘤手术中外中耳结构保留技术的探讨(附2例报告)]

[Exploration of technique for preservation of external-middle ear structure in surgery of jugular foramen paraganglioma (appended 2 case reports)].

作者信息

Song Yongli, Zhu Zhengru, Hu Jian, Pan Yangyang, Qiu Jianhua, Zha Dingjun

机构信息

Department of Otolaryngology Head and Neck Surgery,First Affiliated Hospital of Air Force Medical University,Xi'an,710032,China.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Sep;38(9):818-822;829. doi: 10.13201/j.issn.2096-7993.2024.09.008.

Abstract

To investigate the feasibility and effect of the modified surgery of the classic infratemporal fossa type A approach for the surgical treatment of jugular foramen paraganglioma with preservation of the external and middle ear structures. The medical data of 2 patients with jugular foraminal paraganglioma treated by sublabyrinthic-transmastoid approach were retrospectively analyzed. The clinical feature, degree of tumor resection, postoperative facial nerve function and hearing retention, and the incidence of postoperative complications were evaluated. Two patients were both female, and were pathologically confirmed as paraganglioma. The tumor of case 1 was staged as C2De1, and case 2 as C1De1. Tumors were completely resected in both patients. Case 1 suffered infection after surgery, with residual tympanic membrane perforation and mixed deafness. Case 2 developed mild facial paralysis(grade Ⅱ) after surgery, and recovered after symptomatic treatment. There was no tumor residue or recurrence during half a year of follow-up. Surgical treatment of certain paragangliomas in the jugular foramen with a combined sublabyrinthic-transmastoid and upper neck approach might achieve both complete resection of the tumor and preserving the structure and function of the outer-middle ear. This procedure is suitable for paragangliomas restricted in the jugular foramen area, with no or limited involvement of the internal carotid artery(C1 or C2), and with no or mild hearing loss.

摘要

探讨改良经典颞下窝A型入路手术治疗颈静脉孔区副神经节瘤并保留外耳和中耳结构的可行性及效果。回顾性分析2例采用迷路下-经乳突入路治疗的颈静脉孔区副神经节瘤患者的医学资料。评估其临床特征、肿瘤切除程度、术后面神经功能及听力保留情况,以及术后并发症发生率。2例患者均为女性,病理确诊为副神经节瘤。病例1肿瘤分期为C2De1,病例2为C1De1。2例患者肿瘤均完全切除。病例1术后发生感染,遗留鼓膜穿孔及混合性耳聋。病例2术后出现轻度面瘫(Ⅱ级),经对症治疗后恢复。随访半年无肿瘤残留或复发。采用迷路下-经乳突联合上颈部入路手术治疗部分颈静脉孔区副神经节瘤,可在完全切除肿瘤的同时保留外中耳结构及功能。该术式适用于局限于颈静脉孔区、颈内动脉无或仅有C1或C2轻度受累且无或仅有轻度听力损失的副神经节瘤。

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本文引用的文献

1
[Analysis of the effect of different facial nerve managements applied to tumor resection in the jugular foramen region].
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):368-371;375. doi: 10.13201/j.issn.2096-7993.2024.05.003.
2
[The surgical procedures for tension-free anterior rerouting of facial nerve in infratemporal fossa type A approach].
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul;36(7):549-552. doi: 10.13201/j.issn.2096-7993.2022.07.014.
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Tension-Free Anterior Rerouting of the Facial Nerve in Management of Jugular Foramen Paragangliomas.
Laryngoscope. 2021 Dec;131(12):2684-2687. doi: 10.1002/lary.29658. Epub 2021 May 29.
6
Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications.
Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3S):S21-S25. doi: 10.1016/j.anorl.2018.08.016. Epub 2018 Oct 4.
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