目的:三叉神经鞘瘤是一种罕见的中枢神经系统肿瘤,累及多室颅底。最近,内镜经眶入路(ETOA)已成为一种微创手术技术.这项研究的目的是根据肿瘤分类评估ETOA治疗三叉神经鞘瘤的最佳适应症和临床结果。
方法:在2016年9月至2022年2月之间,在四家三级医院的50例三叉神经鞘瘤患者中进行了ETOA。研究中有15名男性和35名女性,平均年龄46.9岁.所有肿瘤均分类为A型(主要累及中颅窝),B型(主要累及后颅窝),C型(哑铃形肿瘤累及中颅窝和后颅窝),或D型(颅外室受累)。D型肿瘤也通过眼科分类(D1)进行了细分。上颌分区(D2),下颌分区(D3)。分析临床结果,包括切除范围和手术并发症。
结果:在这项研究中,50例患者中有35例(70.0%)进行了总体全切除(GTR),9例(18.0%)进行了接近全切除(NTR).平均随访期为21.9个月(范围1-61.7个月)。随访期间无肿瘤再生长或复发。根据分类,有17个A型肿瘤,20C型,和13个D型。没有B型肿瘤。在13个D型肿瘤中,7个是D1、1个D2和5个D3。对于A型肿瘤,17例患者中有16例(94.1%)使用ETOA实现了GTR或NTR。20例C型肿瘤患者中有18例(90.0%)获得了GTR或NTR。13例D型肿瘤患者中有10例(76.9%)接受了GTR。统计分析表明,肿瘤亚型之间的切除程度没有显着差异。手术并发症包括短暂的部分上睑下垂(n=4),永久性下垂(n=1),短暂性复视(n=7),永久性复视(n=1),角膜角膜病变(n=7),咀嚼困难(n=5),和神经性疼痛或感觉异常(n=14)。随访期间无术后脑脊液漏或眼球内陷。
结论:这项研究表明,在所有肿瘤类型中,三叉神经鞘瘤都可以用微创ETOA有效治疗,除了那些主要涉及后颅窝(B型)。对于颅外舱,D2或D3肿瘤类型通常需要ETOA结合内镜经鼻入路,而D1肿瘤类型可以单独使用ETOA治疗。
OBJECTIVE: Trigeminal schwannoma is a rare CNS tumor and involves the multicompartmental skull base. Recently, the endoscopic transorbital approach (ETOA) has emerged as a technique for minimally invasive surgery. The objective of this
study was to evaluate the optimal indications and clinical outcomes of the ETOA for trigeminal schwannomas based on their tumor classification.
METHODS: Between September 2016 and February 2022, the ETOA was performed in 50 patients with trigeminal schwannoma at four tertiary hospitals. There were 15 men and 35 women in the
study, with a mean age of 46.9 years. All tumors were classified as type A (predominantly involving the middle cranial fossa), type B (predominantly involving the posterior cranial fossa), type C (dumbbell-shaped tumors involving the middle and posterior fossa), or type D (involvement of the extracranial compartment). Type D tumors were also subclassified by ophthalmic division (D1), maxillary division (D2), and mandibular division (D3). Clinical outcome was analyzed, including extent of resection and surgical morbidities.
RESULTS: In this
study, overall gross-total resection (GTR) was performed in 35 (70.0%) of 50 patients and near-total resection (NTR) in 9 patients (18.0%). The mean follow-up period was 21.9 (range 1-61.7) months. There was no tumor regrowth or recurrence during the follow-up period. Based on the classification, there were 17 type A tumors, 20 type C, and 13 type D. There were no type B tumors. Of the 13 type D tumors, 7 were D1, 1 D2, and 5 D3. For type A tumors, GTR or NTR was achieved using an ETOA in 16 (94.1%) of 17 patients. Eighteen (90.0%) of 20 patients with type C tumors attained GTR or NTR. Ten (76.9%) of 13 patients with type D tumors underwent GTR. Statistical analysis showed that there was no significant difference in the extent of resection among the tumor subtypes. Surgical complications included transient partial ptosis (n = 4), permanent ptosis (n = 1), transient diplopia (n = 7), permanent diplopia (n = 1), corneal keratopathy (n = 7), difficulties in mastication (n = 5), and neuralgic pain or paresthesia (n = 14). There were no postoperative CSF leaks or enophthalmos during follow-up.
CONCLUSIONS: This
study showed that trigeminal schwannomas can be effectively treated with a minimally invasive ETOA in all tumor types, except those predominantly involving the posterior fossa (type B). For the extracranial compartments, D2 or D3 tumor types often require an ETOA combined with the endoscopic endonasal approach, while D1 tumor types can be treated using an ETOA alone.