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背景与目的:目前对海绵窦区肿瘤的手术治疗仍是神经外科的难题之一。本文旨在提高海绵窦区肿瘤的全切率,降低神经功能的残障率。方法:针对海绵窦外侧壁的显微解剖特点,结合典型病例分析,回顾性总结了9例海绵窦内肿瘤,经前外侧或外侧硬膜外入路,通过显微神经外科技术切开海绵窦外侧壁夹层,按神经走行方向切开,辨认肿瘤生长和颅神经的关系分块切除肿瘤。结果:9例海绵窦内肿瘤中,海绵状血管瘤1例,神经鞘瘤6例,脑膜瘤2例。全切除5例,3例次全切除,1例大部分切除。3例出现新的颅神经功能障碍症状,6个月后新出现的颅神经功能障碍症状减轻2例,完全恢复1例。结论:明确的海绵窦区显微外科解剖概念,娴熟的显微神经外科技术以及选择适当的手术入路是提高海绵窦区肿瘤的全切率,降低术中出血、术后残障率的关键因素。
BACKGROUND & OBJECTIVE: Currently, the surgical treatment of cavernous sinus tumors remains one of the neurosurgical problems. This paper aims to improve the rate of full-rate caner tumor, reduce the neurological function of the disability rate. Methods: According to the anatomical characteristics of the cavernous sinus lateral wall, combined with typical case analysis, retrospective review of 9 cases of cavernous sinus tumors, anterolateral or lateral epidural approach, by microsurgical techniques incision of the cavernous sinus Lateral wall dissection, incision according to the direction of nerve walking, identify the relationship between tumor growth and cranial nerve block removal of the tumor. Results: Nine cases of cavernous sinus tumors, cavernous hemangioma in 1 case, schwannoma in 6 cases, meningioma in 2 cases. Total resection in 5 cases, 3 cases subtotal resection, 1 case of most resections. 3 cases of new cranial nerve dysfunction symptoms, 6 months after the emergence of symptoms of cranial nerve dysfunction in 2 cases, completely recovered in 1 case. Conclusion: The clear anatomic concept of cavernous sinus microsurgery, skilled neurosurgical techniques and the choice of appropriate surgical approach is to improve the cavernous sinus tumor rate, reduce the intraoperative bleeding, the key factor of postoperative disability .