三叉神经痛型桥小脑角胆脂瘤的临床分析

CHOLESTEATOMA OF THE CEREBELLOPONTINE ANGLE PRESENTED AS TRIGEMINAL NEURALGIA

摘要:

目的：探讨三叉神经痛型桥小脑角胆脂瘤的发生机制、临床表现和治疗原则。方法：24例患者中，18例CT平扫呈低密度，16例行MRI扫描，15例显示肿瘤T1加权像呈低信号，1例为混杂信号，T2加权像均为高信号，CT和MRI均无强化；17例瘤体实质直接包绕三叉神经，7例瘤体在三叉神经前内方将三叉神经压向后下方，3例使神经移位的同时，对侧小脑上动脉压迫三叉神经。结果：13例行肿瘤全切除，9例行肿瘤次全切除，遗留部分包膜未切，2例行大部切除。24例术后面部疼痛停止发作，随访1年以上疼痛未复发。结论：三叉神经痛型桥小脑角胆脂瘤CT和MRI扫描有特征性表现，应采取手术治疗，术中根据肿瘤和周围结构的关系以确定是否全切，对于同时受微血管压迫的病例，除行肿瘤切除外，同时行三叉神经微血管减压术，后多数预后良好。

Abstract:

Objective: To explore the mechanism,clinical manifestation and therapy for cholesteatoma of the cerebellopontine angle presented as trigeminal neuralgia.Methods: Twenty-four patients were involved in this study.CT scans were achieved in 18 patients,showing hypodense mass.MRI scans were achieved in 16 patients,showing hypointense or mixed-intense signal on T1WI and hyperintense signal on T2WI.In 17 cases,the nerve was completely encased by the tumor without displacement.In 7 cases,the nerve was compressed and distorted by the tumor.In 3 cases,the superior cerebellar artery(SCA) on the opposite side compressed the tirgeminal nerve directly in its ventrocranial aspect.Results: The cholesteatoma were totally removed in 13 cases,subtotally removed in 9 cases and partially removed in 2 cases.All patients were clinically cured with follow-up period of more than 1 year.Conclusion: Trigeminal neuralgia may be the initial symptom of the patients with cholesteatoma of the cerebellopontine angle.Total removal cholesteafoma is ideal,but special attention should be paid to preservation of important structures.Besides,possible arterial compression should be inspected,and such an artery should be released by microvascular decompression(MVD) in addition to mere tumor removal.