Patel S J, Sekhar L N, Cass S P, Hirsch B E
Department of Neurosurgery, University of Pittsburgh, Pennsylvania.
J Neurosurg. 1994 Jun;80(6):1026-38. doi: 10.3171/jns.1994.80.6.1026.
Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for glomus jugulare tumors. This publication reports the value of combined surgical approaches in achieving this goal in 12 patients with extensive tumors. Eleven of these tumors were classified as Fisch Class C and/or D, while eight were categorized as Jackson-Glasscock Grade III or IV. Intracranial (intradural) extension was present in 10 patients; four patients had tumor extension into the clivus and two into the cavernous sinus. The petrous internal carotid artery (ICA) was involved in eight and the vertebral artery (VA) in one. Subtemporal-infratemporal, retrosigmoid, and/or extreme lateral transcondylar approaches were added to the usual transtemporal-infratemporal approach. This improved the exposure, provided early control of the petrous ICA, and facilitated tumor removal from the clivus, cavernous sinus, posterior fossa, and foramen magnum, allowing a single-stage resection in eight patients. Ten patients had a complete microscopic resection with no mortality. The facial nerve was preserved in nine cases, with tumor involvement requiring nerve resection followed by grafting in the remaining three. Mobilization of the facial nerve was avoided in five cases; of these, three had intact function and two had House-Brackmann Grade III function on follow-up review. Only one patient had a mild persistent swallowing difficulty. The ICA was preserved in 10 patients and resected in two, while the VA required reconstruction in one case. There were no instances of stroke, and blood transfusions were required in five patients who had tumors with nonembolizable ICA or VA feeders. While complete resection provides the best possibility for cure, the important role of adjuvant radiation therapy in cases with residual tumor is discussed. The importance of degrees of brain-stem compression and vascular encasement is emphasized in classifying the more extensive tumors.
完整切除肿瘤并保留颅神经是当代颈静脉球瘤手术的主要目标。本出版物报告了联合手术入路在12例广泛肿瘤患者中实现这一目标的价值。这些肿瘤中有11例被分类为Fisch C级和/或D级，而8例被分类为Jackson-Glasscock III级或IV级。10例患者存在颅内（硬膜内）扩展；4例患者肿瘤扩展至斜坡，2例扩展至海绵窦。8例累及岩骨段颈内动脉（ICA），1例累及椎动脉（VA）。在通常的经颞下-颞下入路基础上增加了颞下-颞下、乙状窦后和/或极外侧经髁入路。这改善了显露，能早期控制岩骨段ICA，并便于从斜坡、海绵窦、后颅窝和枕骨大孔切除肿瘤，8例患者得以一期切除。10例患者实现了显微镜下完整切除，无死亡病例。9例保留了面神经，其余3例因肿瘤累及面神经而需切除并进行移植。5例避免了面神经移位；其中3例功能完好，2例随访时House-Brackmann分级为III级。仅1例患者有轻度持续性吞咽困难。10例患者保留了ICA，2例进行了切除，1例VA需要重建。无卒中病例，5例肿瘤有不可栓塞的ICA或VA供血支的患者需要输血。虽然完整切除提供了最佳的治愈可能性，但也讨论了辅助放疗在残留肿瘤病例中的重要作用。在对更广泛的肿瘤进行分类时，强调了脑干受压程度和血管包绕的重要性。
