發(fā)布時(shí)間：2018-07-28 07:47

【摘要】：目的：海綿竇區(qū)腫瘤常見者為腦膜瘤、神經(jīng)鞘瘤及海綿狀血管瘤。而相對(duì)罕見的脊索瘤樣腦膜瘤、表皮樣囊腫及腺樣囊性癌的臨床報(bào)道較少。以我科成功手術(shù)治療的海綿竇區(qū)表皮樣囊腫、脊索瘤樣腦膜瘤及腺樣囊性癌為例，結(jié)合相關(guān)文獻(xiàn)總結(jié)其臨床診治經(jīng)驗(yàn)，以提高術(shù)前診斷準(zhǔn)確率，并選擇合適的手術(shù)入路提高腫瘤切除率。 方法：回顧性分析我科成功手術(shù)治療的海綿竇區(qū)脊索瘤樣腦膜瘤、表皮樣囊腫及腺樣囊性癌的臨床資料，復(fù)習(xí)國內(nèi)外相關(guān)文獻(xiàn)，比較海綿竇區(qū)腦膜瘤、神經(jīng)鞘瘤、海綿狀血管瘤、表皮樣囊腫、脊索瘤樣腦膜瘤及腺樣囊性癌的臨床表現(xiàn)、影像學(xué)及病理學(xué)特征。從常用手術(shù)入路的解剖關(guān)系、術(shù)中處理措施及可能導(dǎo)致的術(shù)后并發(fā)癥的角度，比較不同手術(shù)入路的優(yōu)缺點(diǎn)。 結(jié)果：海綿竇區(qū)腫瘤的臨床表現(xiàn)無明顯特異性，臨床癥狀主要表現(xiàn)為III～VI顱神經(jīng)受累。腺樣囊性癌多由其它部位侵襲至顱內(nèi)，可有原發(fā)灶相關(guān)的癥狀體征。神經(jīng)鞘瘤多起源于神經(jīng)鞘膜細(xì)胞，所以常以神經(jīng)刺激和神經(jīng)麻痹為首發(fā)癥狀。 MRI上，腦膜瘤大多均勻一致強(qiáng)化，脊索瘤樣腦膜瘤常呈不均勻強(qiáng)化，神經(jīng)鞘瘤可呈均勻或不均勻強(qiáng)化，而腺樣囊性癌不均勻強(qiáng)化，呈大小不同的囊腔。在彌散加權(quán)成像(DWI)上，表皮樣囊腫呈高信號(hào)，具有特異性，但不強(qiáng)化。海綿竇區(qū)海綿狀血管瘤在T2W像上中呈明顯高信號(hào)，增強(qiáng)掃描顯示其強(qiáng)化程度高于腦膜瘤。 腦膜瘤與脊索瘤樣腦膜瘤病理組織學(xué)相似，脊索瘤樣腦膜瘤D2-40蛋白表達(dá)陽性，而腦膜瘤表達(dá)陰性。神經(jīng)鞘瘤由梭形細(xì)胞或小的星狀細(xì)胞組成，伴有各種退行性變，S-100、Leu-7常呈陽性，局灶性GFAP呈陽性。海綿狀血管瘤由血管竇組成，VEGF相關(guān)受體表達(dá)增高。表皮樣囊腫呈結(jié)節(jié)狀或囊狀，內(nèi)容物可見鈣化和泥沙樣改變。腺樣囊性癌的特征性組織學(xué)征象是團(tuán)塊狀增生的腫瘤細(xì)胞，呈篩狀及腺樣排列。 手術(shù)切除海綿竇區(qū)腫瘤可經(jīng)翼點(diǎn)或改良翼點(diǎn)入路，，若腫瘤涉及眼眶者可取額眶顴入路，對(duì)于后部海綿竇腫瘤可取顳下經(jīng)顴弓入路。經(jīng)顳下鎖孔入路可切除大部分海綿竇區(qū)腫瘤。 結(jié)論：1、海綿竇區(qū)腫瘤的臨床癥狀常不典型，主要表現(xiàn)為海綿竇綜合征；2、MRI增強(qiáng)掃描有助于海綿竇區(qū)腫瘤的鑒別診斷，確診有賴于手術(shù)后病理結(jié)果；3、經(jīng)顳下鎖孔入路可切除大部分海綿竇區(qū)腫瘤。
[Abstract]:Objective: meningioma, neurilemmoma and cavernous hemangioma are common tumors in cavernous sinus. But relatively rare chordomatoid meningiomas, epidermoid cysts and adenoid cystic carcinomas are rarely reported. The successful surgical treatment of epidermoid cyst, chordomatoid meningioma and adenoid cystic carcinoma of cavernous sinus region in our department was taken as an example. The clinical experience of diagnosis and treatment was summarized in combination with the relevant literature in order to improve the accuracy of preoperative diagnosis. The appropriate surgical approach was chosen to improve the tumor resection rate. Methods: the clinical data of spinal cord meningioma, epidermoid cyst and adenoid cystic carcinoma of cavernous sinus treated successfully by our department were analyzed retrospectively. Clinical, imaging and pathological features of cavernous hemangioma, epidermoid cyst, chordomatoid meningioma and adenoid cystic carcinoma. The advantages and disadvantages of different operative approaches were compared from the anatomic relationship of common operative approaches, intraoperative management measures and possible postoperative complications. Results: the clinical manifestations of cavernous sinus tumors were not obvious. The main clinical symptoms were III~VI cranial nerve involvement. Adenoid cystic carcinoma usually invades the brain from other sites and may have symptoms and signs associated with primary lesions. Neurilemmoma often originates from nerve sheath cells, so it is often characterized by nerve stimulation and paralysis. On MRI, meningiomas are mostly uniformly enhanced, and chordomatoid meningiomas are often unevenly enhanced. Neurilemmoma showed homogeneous or uneven enhancement, while adenoid cystic carcinoma showed heterogeneous enhancement with different size of cystic cavity. On diffusion-weighted (DWI), epidermoid cysts showed high signal intensity, specificity, but no enhancement. Cavernous hemangioma in cavernous sinus area showed obvious high signal intensity on T 2 W image, and enhanced degree was higher than that of meningioma on contrast enhanced scan. The histopathology of meningioma and chordomatoid meningioma was similar. The expression of D2-40 protein was positive in chordomatoid meningioma, but negative in meningioma. Neurilemmoma consists of spindle cells or small stellate cells with various degenerative changes: S-100 Leu-7 is usually positive and focal GFAP is positive. The expression of VEGF-related receptors in cavernous hemangioma is increased. Epidermoid cysts were nodular or cystic with calcification and silt-like changes in the contents. The characteristic histological features of adenoid cystic carcinoma are lump-like proliferative tumor cells arranged in ethmoid and glandular form. Surgical resection of cavernous sinus tumors can be performed via pterygoid or modified pterygoid approach. If the tumor involves orbit, frontoorbital zygomatic approach can be obtained, and for posterior cavernous sinus tumors, subtemporal approach via zygomatic arch should be adopted. Most cavernous sinus tumors can be removed via subtemporal keyhole approach. Conclusion the clinical symptoms of cavernous sinus tumors are often atypical. The main manifestations are that the enhanced MRI scan of cavernous sinus syndrome is helpful to the differential diagnosis of cavernous sinus tumors, and the diagnosis depends on the pathological results after surgery. 3. Most cavernous sinus tumors can be resected via subtemporal keyhole approach.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張劍寧 ,章翔 ,郭衍 ,曹衛(wèi)東 ,李兵 ,屈延 ,甄海寧 ,高大寬;改良翼點(diǎn)入路顯微直視手術(shù)切除海綿竇腫瘤[J];解放軍醫(yī)學(xué)雜志;2002年07期

2 陸富生;馮志博;王仲偉;;改良翼點(diǎn)入路的解剖及其臨床應(yīng)用[J];解剖與臨床;2005年04期

3 史彥芳,張保中;原發(fā)性海綿竇腫瘤的臨床[J];中國臨床神經(jīng)科學(xué);2001年02期

4 劉志雄,劉運(yùn)生,袁賢瑞,劉景平,侯永宏,丁錫平,陳凌,曹美鴻;經(jīng)額顳硬膜外入路顯微手術(shù)切除海綿竇區(qū)腫瘤[J];中華神經(jīng)外科疾病研究雜志;2002年02期

5 周良輔,毛穎,陳亮;海綿竇海綿狀血管瘤的診斷和治療[J];中華神經(jīng)外科疾病研究雜志;2003年01期

6 樓美清,盧亦成,丁學(xué)華,白如林,胡國漢,陳志剛,駱純,侯立軍,陳先震,吳小軍;兩種不同入路切除海綿竇區(qū)腫瘤的比較[J];中華神經(jīng)外科疾病研究雜志;2004年06期

7 黃忻濤;郝解賀;;眶顴入路的應(yīng)用解剖[J];山西醫(yī)科大學(xué)學(xué)報(bào);2008年03期

8 施紅旗;朱壽田;樓善賢;;兒童脊索樣腦膜瘤二例并文獻(xiàn)復(fù)習(xí)[J];實(shí)用腫瘤學(xué)雜志;2008年01期

9 朱海青;沈靜;張巧全;梁為儉;周金寶;;脊索瘤樣腦膜瘤的臨床與病理特點(diǎn)[J];中國現(xiàn)代神經(jīng)疾病雜志;2008年04期

10 周國勝,張新中,周文科,史耀亭,王利軍;改良翼點(diǎn)入路操作技術(shù)及其臨床應(yīng)用[J];新鄉(xiāng)醫(yī)學(xué)院學(xué)報(bào);2003年01期

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