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題名 | Microsurgical Management of Intracranial Epidermoid Cysts=外科顯微手術治療顱內表皮樣腫瘤 |
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作者 | 沈炯祺; 王有智; 魏善華; 張正修; 詹益禎; 呂慶祥; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:6 1998.06[民87.06] |
頁次 | 頁313-323 |
分類號 | 416.291 |
關鍵詞 | 非細菌性腦膜炎; 小腦橋腦角; 表皮樣腫瘤; 電腦斷層掃描; 水腦; 磁振掃描; 三叉神經痛; Aseptic meningitis; Cerebellopontine angle; Computed tomography; Epidermoid cyst; Hydrocephalus; Magnetic resonance imaging; Trigeminal neuralgia; |
語文 | 英文(English) |
中文摘要 | 背景:顱內表皮樣腫瘤是生長很慢的先天性腫瘤,通常生長於顱底的腦池,特別是在小腦橋 腦角、蝶鞍附近。它們也常發生於腦室、腦內、腦幹或松果體部。它們在生長過程中通常會包住顱神經、 血管及重要的神經結構,使得手術的困難度增加。但是近年來放射診斷工具的進步,如電腦斷層掃描、 磁振掃描,使得我們於術前能掌握此腫瘤的分布,而使手術能完全切除腫瘤,並避免併發症的發生。 方法:從1984年7月至1997年6月期間共有26個病例接受外科顯微手術治僚。年齡從20歲至68歲。18位女性、 8位男性。腫瘤位於小腦橋腦角佔20位,其中4位腫瘤合併中顱凹及蝶鞍附近的擴展,大部份病人以三 叉神經痛表現貿16例),另外有2例以頭痛、頭暈表現,1例走路不穩,1例顏面神經痙攣。2例第三腦室 腫瘤以頭痛及半邊肢體無力表現,2例第4腦室及2例松果體腫瘤以走路不穩表現。神經放射學的檢查 包括電腦斷層掃描及電腦斷層腦池攝影或磁振掃描。 結果:腫瘤能完全切除有12例(佔46.2%),幾乎完全切除腫瘤(只留下極少部份包膜有7例9佔26.9%), 部份切除腫瘤(留下部份包膜)有6例(佔23.1%,另外有1例松果體部的腫瘤接受立體定位切片檢查。術 後神經障礙有3例、1例聽力喪失及輕微顏面神經痲痺、1例術後仍然有三叉神經痛、另1例術後走路不 穩。4例發生非細菌性腦膜炎,3例水腦症接受腦室腹腔引流術。術後神經功能進步者25例,只有1例 術後功能變差。在26位病人中,有3位病人分別於術後三個月、六個月及九個月因肺炎死亡。 結論:術前很好的放射學檢查,尤其是磁振掃描能提供腫瘤的大小、位置及相關的結構,使我們更有 信心的將腫瘤完全切除及保留神經功能。對於較深、困難度高或很嚴重的腫瘤粘黏重要神經血管的病 例,則只能盡量的切除腫瘤以避免傷及重要神經結構,而遺留神經功能的障礙。 |
英文摘要 | Background: Intracranial epidermoid cysts are slow-growing congenital neoplasms that usually spread and adhere to critical neurovascular structures along the basal cistern, particularly the cerebellopontine angle (CPA) and parasellar region. Clinical symptoms include trigeminal neuralgia, headache and dizziness, progressive hemiparesis, unstable gait and hemifacial spasm. With the aid of modern imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), an effective microsurgical approach can be planned preoperatively to completely remove tumors and avoid complications. Methods: Twenty-six patients with intracranial epidermoid cysts were microsurgically treated between July 1984 and June 1997. Diagnostic procedures included enhanced CT and/or CT cisternography and MRI. All patients underwent microsurgical treatment for tumor removal. Results: Total tumor removal was achieved in 12 patients (46.2%), near-total removal in seven (26.9%), partial removal in six (23.1%) and stereotactic biopsy in one patient (3.8%). Postoperative deterioration of the neurologic condition was found in three patients who required further surgery, aseptic meningitis in four patients and communicating hydrocephalus requiring shunting in three patients. The functional prognoses were excellent in 23 patients (88.5 %), good in two patients (7.7%) and fair in one patient (3.8%). Among the 26 patients, three died of pneumonia three, six and nine months after surgery, respectively. Conclusions: MRI is particularly useful for defining the anatomic limits of tumor tissue and surgical planning. The surgical results were excellent in patients with near-total tumor removal, as well as in patients with total removal. Aggressive surgical tumor removal may result in transient, but significant, cranial nerve palsy and should be avoided. Perioperative administration of steroids and wound protection may be beneficial for preventing the development of postoperative aseptic meningitis and hydrocephalus. |
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