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目的回顾应用枕下经颈静脉突(STJP)入路手术切除的颈静脉孔(JF)肿瘤病例,探讨该人路的临床价值及适用范围。方法回顾总结自2000年1月以来STJP入路14例和枕下-颞下窝联合入路1例切除的JF肿瘤病人的临床资料、手术入路及术后随访情况。结果本组14例JF肿瘤中,1例肿瘤局限于JF区；5例肿瘤完全向颅内发展；8例肿瘤主体位于颅内,其中2例部分瘤体向下跨枕大孔进入颈椎管上部,6例部分瘤体经JF向外口处发展,呈哑铃型,后者中有2例向前累及颈动脉鞘。手术全切除10例；近全切除1例；次全切除3例。术后无1例发生脑脊液漏。13例(92．9%)患者未新增颅神经损害症状,1例术后出现短期患侧眼外展麻痹和面神经不全损害(HBⅢ级)。术后随访3-60个月(失访1例),病人术前颅神经损害均逐渐恢复或代偿,随访时无1例存在吞咽困难。1例肿瘤颅外部分发展至颞下窝咽旁间隙采用枕下-颞下窝联合入路的患者术后出现后组颅神经损害表现,伴短期切口脑脊液漏。鼻饲4个月时因水、电解质紊乱合并肺部感染死亡。结论STJP入路操作简便易行,无需磨除岩骨及轮廓化面神经管,不破坏迷路,对颅底骨质破坏较少,显露范围较广泛,适用于主体在JF区和向颅内发展的JF肿瘤切除。
Objective To review the cases of jugular foramen (JF) resected by transthoracic jugular vein (STJP) approach and explore the clinical value and applicability of this approach. Methods The clinical data, surgical approach and postoperative follow - up of 14 patients with JF tumor who underwent combined STJP approach and suboccipital - infratemporal fossa approach since January 2000 were reviewed. Results In the group of 14 cases of JF tumors, 1 case of tumor was confined to the JF region; 5 cases of tumors developed completely to the brain; 8 cases of tumor located in the skull, of which 2 cases of tumor down across the occipital foramen into the upper cervical canal , 6 cases of part of the tumor by the JF to the mouth of the development, was dumbbell type, the latter two cases involving the carotid sheath forward. Surgical resection in 10 cases; nearly total resection in 1 case; subtotal resection in 3 cases. No postoperative cerebrospinal fluid leakage occurred in 1 patient. Thirteen patients (92.9%) had no symptoms of cranial nerve damage, and one patient had short-term ipsilateral paralysis of the eye and facial insufficiency (HBⅢ). The patients were followed up for 3 to 60 months (1 patient lost to follow-up). The patients’ cranial nerve damage recovered or compensated gradually. None of the patients had dysphagia at follow-up. One case of extracranial tumor developed into the space of parapharyngeal parapharyngeal space. Subclavian - infratemporal fossa approach combined with cranial nerve injury occurred in the posterior group, with short-term incision cerebrospinal fluid leakage. Nasal feeding for 4 months due to water, electrolyte imbalance and pulmonary infection death. Conclusions STJP approach is simple and easy to operate. It is not necessary to remove the petrous bone and contoured facial nerve canal without destroying labyrinth. It has less damage to the skull base and more extensive exposure. It is suitable for the development of the main body in the JF area and intracranial JF tumor resection.