Sekhar L N, Tzortzidis F N, Bejjani G K, Schessel D A
Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA.
J Neurosurg. 1997 Jun;86(6):1036-41. doi: 10.3171/jns.1997.86.6.1036.
Glomus jugulare tumors always invade the jugular bulb and sigmoid sinus, making it difficult to resect these tumors totally without sacrificing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconstruction of the jugular bulb using a saphenous vein graft may enable tumor resection in these patients without complications. The authors describe two cases of saphenous vein grafting used to bypass the sigmoid sinus. The first case is that of a 61-year-old man with a glomus jugulare tumor that invaded the dominant sigmoid sinus, which was poorly collateralized. Temporary occlusion of the sinus during surgery caused a 15-mm Hg increase in intrasinus pressure, without brain swelling or changes in evoked potentials. A saphenous vein graft was used to bypass the sigmoid sinus and jugular bulb and to allow for total tumor removal. The patient had a good outcome. The second case is that of a 41-year-old man with a left glomus jugulare tumor and another smaller tumor on the opposite, dominant sinus. The left glomus jugulare tumor was resected via a two-stage procedure. A saphenous vein graft was used to reconstruct the left sigmoid sinus because of the presence of contralateral disease, with the potential for bilateral sigmoid sinus occlusion. An evaluation of the venous collateral circulation during jugular foramen surgery and the prevention of complications are also discussed.
颈静脉球瘤总是侵犯颈静脉球和乙状窦,因此在不牺牲受累窦的情况下完全切除这些肿瘤很困难。尽管在大多数患者中可以安全地牺牲窦,但少数患者会出现严重后果。使用大隐静脉移植重建颈静脉球可能使这些患者能够切除肿瘤而不发生并发症。作者描述了两例使用大隐静脉移植绕过乙状窦的病例。第一例是一名61岁男性,患有侵犯优势乙状窦的颈静脉球瘤,该窦的侧支循环较差。手术期间临时阻断窦导致窦内压力升高15mmHg,无脑肿胀或诱发电位变化。使用大隐静脉移植绕过乙状窦和颈静脉球,以便完全切除肿瘤。患者预后良好。第二例是一名41岁男性,患有左侧颈静脉球瘤,对侧优势窦上还有另一个较小的肿瘤。左侧颈静脉球瘤通过两阶段手术切除。由于对侧存在病变,有双侧乙状窦闭塞的可能性,因此使用大隐静脉移植重建左侧乙状窦。还讨论了颈静脉孔手术期间静脉侧支循环的评估和并发症的预防。