Cusimano M D, Sekhar L N, Sen C N, Pomonis S, Wright D C, Biglan A W, Jannetta P J
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Neurosurgery. 1995 Jul;37(1):1-9; discussion 9-10. doi: 10.1227/00006123-199507000-00001.
CAVERNOUS SINUS SURGERY has been performed increasingly in the last 2 decades because of new knowledge and technologies. With increasing international expertise in cavernous sinus surgery, the results must be analyzed critically to search for accurate prognosticators of outcome. We performed a retrospective review of 124 patients (40 male, 84 female; mean age, 45 years) who underwent cavernous sinus surgery for benign tumors from 1983 to 1992. Sixty-five percent had tumors encasing the internal carotid artery. Mean follow-up was 29 months (median, 26 mo). Gross total or near-total resection was possible in 80%. Patients with neurilemomas, angiofibromas, epidermoids, chondroblastomas, and hemangiomas were more likely to have total or near-total resection (100% versus 75%, P < 0.025). Disabling complications (five cerebral infarctions, two meningitis, and one hydrocephalus with chiasmal prolapse) occurred only in patients with meningiomas or pituitary adenomas. On follow-up, excellent/good binocular vision was achieved in 53% of patients entering surgery with excellent/good function versus 25% who entered surgery with fair/poor binocular vision (P < 0.025). Ninety-three percent of patients had a Karnofsky score > or = 70 on follow-up. There were a total of 12 recurrences (10%), 6 in patients with meningiomas, 2 in patients with angiofibromas, 2 in patients with craniopharyngiomas, 1 in a patient with a pituitary adenoma, and 1 in a patient with an osteoblastoma. Patients with tumor growth or neurological symptoms indicative of progressive cavernous sinus involvement should undergo cavernous sinus exploration. This surgery has acceptable morbidity and mortality and, if the tumor can be removed easily, the surgeon should try to perform radical tumor resection. To avoid major complications, the surgeon must exercise utmost care to preserve the neurovascular structures of the cavernous sinus, with special attention to tumors that extend into the petroclival region. Better results from surgery can be expected in those patients with neurilemomas, hemangiomas, or epidermoids than in patients with meningiomas, craniopharyngiomas, or pituitary adenomas. Good functional outcome can be expected, particularly if the patient's preoperative clinical status is good. Particular attention must be paid to the reconstruction of anatomic barriers in order to prevent cerebrospinal fluid leakage and subsequent meningitis.
由于新知识和新技术的出现，海绵窦手术在过去20年中越来越多地开展。随着国际上对海绵窦手术专业知识的不断增加，必须对手术结果进行严格分析，以寻找准确的预后指标。我们对1983年至1992年间因良性肿瘤接受海绵窦手术的124例患者（40例男性，84例女性；平均年龄45岁）进行了回顾性研究。65%的患者肿瘤包绕颈内动脉。平均随访时间为29个月（中位数为26个月）。80%的患者能够实现大体全切或近全切。神经鞘瘤、血管纤维瘤、表皮样囊肿、软骨母细胞瘤和血管瘤患者更有可能实现全切或近全切（100%对75%，P<0.025）。致残性并发症（5例脑梗死、2例脑膜炎和1例伴有视交叉脱垂的脑积水）仅发生在脑膜瘤或垂体腺瘤患者中。随访时，术前双眼视力良好/优秀的患者中，53%术后双眼视力仍保持良好/优秀，而术前双眼视力一般/较差的患者中这一比例为25%（P<0.025）。93%的患者随访时卡氏评分≥70分。共有12例复发（10%），其中脑膜瘤患者6例，血管纤维瘤患者2例，颅咽管瘤患者2例，垂体腺瘤患者1例，成骨细胞瘤患者1例。有肿瘤生长或出现提示海绵窦进行性受累的神经症状的患者应接受海绵窦探查。该手术的发病率和死亡率可接受，如果肿瘤能够轻易切除，外科医生应尝试进行根治性肿瘤切除。为避免严重并发症，外科医生必须极其小心地保护海绵窦的神经血管结构，尤其要注意延伸至岩斜区的肿瘤。与脑膜瘤、颅咽管瘤或垂体腺瘤患者相比，神经鞘瘤、血管瘤或表皮样囊肿患者手术效果可能更好。如果患者术前临床状况良好，有望获得良好的功能预后。必须特别注意重建解剖屏障，以防止脑脊液漏和随后发生的脑膜炎。
