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目的:总结8例向颅内扩展的巨型鼻咽血管纤维瘤(JNA)患者手术成败的经验教训,提出围手术期处理应注意的事项。方法:8例男性患者,均为分别侵入前和(或)中颅窝的巨型JNA,其中颈内动脉颅内段参与肿瘤供血者4例,复发再次手术3例。术前均酌情选用CT、CT血管造影、MRI和(或)磁共振血管造影进行影像学评估;DSA技术检测肿瘤供血范围,并超选择性栓塞瘤体供血。8例均采取颅面联合入路的方法。结果:5例完整切除,3例部分切除。3例未能全切的原因为:2例因早期未行DSA技术血管栓塞,术中出血过多而失败,1例因错估影像学检查而遗漏对侧蝶窦的肿瘤分叶。结论:得当的以手术为中心的围手术期处理是减少术中出血、彻底切除肿瘤,避免并发症的重要保障。
OBJECTIVE: To summarize the experiences and lessons of eight patients with giant nasopharyngeal angiofibroma (JNA) who have undergone intracranial expansion, and to point out the issues to be considered during the perioperative management. Methods: All the 8 male patients were giant JNA before and / or in the middle cranial fossa. Among them, 4 cases were involved in the intracranial internal carotid artery, 3 cases were treated by recurrent and recurrent tumors. CT and CT angiography, MRI and / or magnetic resonance angiography were used to evaluate the imaging before surgery. DSA was used to detect the extent of tumor blood supply and superselective embolization of the tumor. 8 cases were taken craniofacial approach. Results: Complete resection in 5 cases and partial resection in 3 cases. Three cases failed to complete the cut because: 2 cases of early vascular DSA without embolic surgery, excessive bleeding and failure, 1 case due to misdiagnosis of the imaging examination and missed the sphenoid lobes of the tumor. Conclusion: Appropriate operation-centered perioperative management is an important guarantee to reduce intraoperative bleeding, complete tumor removal and avoid complications.