Objective: To explore the effects of paracondylar-lateral cervical approach for resection of the jugular foramen schwannoma(JFS). Methods: A total of 15 patients with JFS operated via the paracondylar-lateral cervical approach between December 2011 and March 2016 at Department of Neurosurgery in Xiangya Hospital of Central South University were retrospectively analyzed. There were 7 males and 8 females, aging from 22 to 77 years with a mean age of (41.9±15.8) years.There were 12 patients who accepted primary surgery, 3 patients who accepted secondary surgery. There were 10 patients with tinnitus or hearing loss, 8 patients with dysphagia, 9 patients with hoarseness, 7 patients with tongue hemiparesis, 8 patients with ataxia, 1 patient with Pyramidal signs, 2 patients with facial hypesthesia or pain, 1 patient with facial paresis. According to Samii JFS grading system, 2 patients were type B, 4 were type C and 9 were type D. All patients were followed-up through outpatient and telephone by MRI in 3, 9, 12 months postoperation. Results: Gross total removal of tumors were achieved in 14 patients and subtotal removal in 1 patient. Two patients had new hoarseness, 2 had new dysphagia and 3 had more serious dysphagia, 1 patient had more serious facial paresis after the operation. There were 2 patients with intracranial infection, 2 with pneumonia, 1 with subcutaneous effusion, 1 with cerebrospinal fluid rhinorrhea, 5 with gastric intubation during perioperative period. There were no death, intracranial hematoma and decreased hearing patients. All patients were followed up, the follow-up time were 3 to 33 months with a mean of (26.9±11.2) months. Till to the latest follow up, dysphagia improved in 2 cases, hoarseness and tongue hemiparesis improved in 3 cases, hearing loss and tinnitus improved in 9 cases, balance function improved in 7 cases, facial hypesthesia and pain improved in 2 cases, pyramidal signs disappeared in 1 case, facial nerve function improved to normal in 1 case. There was no recurrence and progressed case. Conclusion: Paracondylar-lateral cervical approach is an alternative approach for both intracranial and extracranial JFS.
目的： 探讨髁旁－颈外侧入路切除颈静脉孔神经鞘瘤的临床效果。 方法： 回顾性分析2011年11月至2016年3月中南大学湘雅医学院神经外科收治的15例采用髁旁－颈外侧入路一期切除颈静脉孔神经鞘瘤的患者资料，男性7例，女性8例，年龄22～77岁，平均(41.9±15.8)岁。12例为首次手术，3例为再次手术。临床表现和体征包括：耳鸣、听力下降10例；吞咽、饮水困难8例；声音嘶哑9例；伸舌偏向病灶侧7例；闭目难立及共济失调等小脑体征8例；病灶对侧肌力减退1例；面部麻木或疼痛2例；面神经功能为2级者1例。根据颈静脉孔神经鞘瘤分型：B型2例，C型4例，D型9例。通过门诊或电话随访，术后3、9、12个月复查颅底MRI，观察肿瘤有无复发和颅神经功能变化情况。 结果： 14例患者肿瘤全部切除，1例次全切除。术后新发吞咽困难2例，吞咽困难较术前加重3例；新发声嘶2例；面瘫加重1例；颅内感染2例，肺部感染2例，皮下积液1例，脑脊液鼻漏1例，术后5例留置胃管。无围手术期死亡、颅内出血和听力下降病例。随访时间3～33个月，平均(26.9±11.2)个月。2例吞咽功能较术前改善，3例声音嘶哑较术前减轻，3例伸舌偏斜改善，9例听力改善和(或)耳鸣消失，1例面神经功能恢复正常，7例平衡功能较术前改善。2例术前面部麻木或疼痛患者、1例肌力下降患者神经功能均恢复至正常。随访结束时无肿瘤复发及进展病例。 结论： 髁旁－颈外侧入路是切除颅内外沟通颈静脉孔神经鞘瘤的一种入路选择。.
Keywords: Jugular foramen; Paracondylar-lateral cervical approach; Schwannomas; Skull base neoplasms; Surgical approach.