海绵窦区肿瘤87例显微手术的临床分析

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目的:探讨海绵窦区肿瘤显微手术的疗效。方法:回顾性分析2010年1月至2019年8月87例接受显微手术治疗的海绵窦区肿瘤患者的临床资料,探讨海绵窦区常见肿瘤的手术入路及显微手术技巧。随访方式包括门诊及电话随访,随访结果以KPS评分进行评估。结果:肿瘤切除率:57例(65.5%)全切除,14例(16.1%)次全切除,16例(18.4%)大部分切除;住院时间14~98 d,平均29 d;并发症:脑神经受损30例,脑干受损2例,术后出血4例,脑脊液漏5例,感染4例,垂体受损1例,死亡1例;预后及随访:术后1个月KPS评分超过60分68例,超过80分66例。术后3个月KPS评分超过70分74例,超过80分72例。术后12个月KPS评分超过80分78例。随访6~120个月期间死亡3例;6例未全切除脑膜瘤术后1~6年复发,4例未全切除神经鞘瘤术后1~8年复发,2例垂体瘤腺瘤术后13个月及16个月复发,均再次手术治疗后随访无复发。2例软骨肉瘤、3例脊索瘤、3例生殖细胞瘤术后予以放射治疗,随访期间病灶未进展。其余病例随访期间肿瘤无进展或复发。结论:海绵窦区肿瘤手术困难,术后并发症较多;合理的术前规划和手术入路,以及具备精准显微外科手术技巧是降低术后并发症、提高临床预后的关键。“,”Objective:To investigate the efficacy of microsurgical treatment in cavernous sinus tumors.Methods:The clinical data of 87 patients with cavernous sinus tumor treated by microsurgery from January, 2010 to August, 2019 were analysed retrospectively. The surgical approaches and microsurgical skills for common tumors in Cavernous Sinus region were discussed. The follow-up included outpatient and telephone follow-ups, and the follow-up results were evaluated by KPS score.Results:Among the 87 cases, 57 were totally resected (65.5%), 14 were subtotal resected (16.1%) and 16 were major resected (18.4%). Hospitalisation ranged from 14 to 98 days, with an average of 29 days. Postoperative complications occurred in 30 cases with cranial nerve injury, 2 brain stem injury, 4 postoperative bleeding, 5 cerebrospinal fluid leakage, 4 infection, 1 Pituitary damage and 1 death. Prognosis and follow-up analysis showed 68 cases with KPS>60 and 66 with KPS>80 at 1 month after surgery; 74 with KPS>70 and 72 with KPS>80 at 3 months after surgery; 78 with KPS>80 by 12 months after surgery. During the follow-up period of 6-120 months, 3 cases died. Recurrence: 6 of incomplete resection of meningioma, were in 1-6 years after the surgery, 4 of incomplete resection of schwannoma in 1-8 years, 2 of pituitary adenoma respectively in 13 and 16 months after the surgery. There was no recurrence after reoperation. Two cases of chondrosarcoma, 3 of chordoma and 3 of germinoma were treated with radiotherapy, and during the follow-up, there was no progress of the focus. No tumor progression or recurrence was found in other cases during follow-up.Conclusion:Surgery of cavernous sinus tumor is difficult due to frequent postoperative complications. Reasonable preoperative plan, surgical approach and precise microsurgical techniques are the keys in reduction of postoperative complications and in the improvement of prognosis.
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