The surgical outcomes in management of jugular foramen paragangliomas with tension free anterior rerouting of the facial never and tunnel packing of the inferior petrous sinus
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摘要: 目的 探讨改良颞下窝A型入路——无张面神经前移位联合岩下窦隧道填塞术治疗颈静脉孔区副神经节瘤(jugular foramen paragangliomas，JFP)的安全性和有效性。方法 本研究纳入2010年10月至2023年6月就诊于复旦大学附属眼耳鼻喉科医院耳鼻喉科的JFP患者88例，对肿瘤分期、术中情况以及术后面神经(facial nerve，FN)，后组颅神经(lower cranial nerves，LCN)功能进行分析。结果 所有患者肿瘤全切70例(79.5%)及近全切17例(19.3%)，仅1例患者次全切除；术中平均出血量448.3 mL。经典面神经全移位24例(27.3%)，改良无张面神经全移位18例(20.5%)、改良无张面神经部分移位18例(20.5%)。经典面神经前移位和无张面神经前移位术后面神经HBⅠ~Ⅱ级分别为62.5%和88.9%，通过Kruskal Wallis检验分析，差异有统计学意义(P=0.007)，无张面神经移位能有效保护面神经功能。术前组LCN功能损伤(20例，22.7%)，术后新发LCN功能损伤[C1~C2期患者占4.9%(2/41)、C3-D期患者占8.5%(4/47)]，早期手术对LCN功能影响更小。结论 改良颞下窝A型入路可改善患者预后：无张面神经前移位能有效保护面神经功能，岩下窦隧道填塞术能更好保护后组颅神经功能并减少术中出血。
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关键词:
- 颈静脉孔区副神经节瘤 /
- 无张面神经前移位 /
- 岩下窦隧道填塞 /
- 外科手术
Abstract: Objective The aim of this study is to evaluate the safety and efficacy of surgical interventions ofjugular foramen paragangliomas(JFP) utilizing modified surgical techniques, tensionfree anterior rerouting of the facial nerve and tunnel-packing or push-packing of the inferior petrous sinus.Methods A retrospective analysis was conducted on a cohort of 88 patients diagnosed with JFP and treated at the Eye Ear Nose and Throat Hospital of Fudan University(in Shanghai, China) from October 2010 to June 2021. The surgical outcomes were analyzed for tumor classification, intraoperative conditions, and function of the postoperative facial nerve(FN) and lower cranial nerve(LCN).Results The study included a total of 88 patients, gross total resection was achieved in 70 patients(79.5%), near total resection was obtained in 17 patients(19.3%), and one patient undergoing subtotal resection. The average of intraoperative blood loss was 448.3 mL. Additionally, 24 patients underwent surgical total anterior rerouting(TAR), 18 patients underwent surgical total FN tension free anterior rerouting(TF-TAR), and 18 patients underwent surgical FN partial FN tension free anterior rerouting(TF-PAR). Good postoperative FN function(House-Brackmann Ⅰ-Ⅱ) was achieved in 62.5% of TAR group. In the TF-TAR and PF_TAR groups, good postoperative FN function was demonstrated in 88.9% patients. It showed a significantly improvement of the FN function following application of tension-free FN anterior rerouting technique(P=0.007). Twenty patients(22.7%) suffered from at least one LCN deficit in the preoperative evaluation. The postoperative LCN deficits was correlated with the Fisch classification of tumors, which showed a lower incidence of LCN dysfunction in classes C1-C2(4.9%, 2/41cases) and poorer outcomes of LCN dysfunction in classes C3-D(8.5%, 4/47cases), it was likely less impacted the LCN function in the early stage tumor.Conclusion The application of modified surgical techniques of FN tension-free anterior rerouting and tunnel-packing of the inferior petrous sinus has been shown to effectively preserve the function of the FN and LCN, decrease intraoperative blood loss, and ultimately improve patients' postoperative quality of life. -
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表 1 术后FN功能
FN手术方式 例数 术后FN功能/例(%) HB分型
Ⅰ~ⅡHB分型
Ⅲ~VIFN前移位 24 15(62.5) 9(37.5) 无张FN前移位 18 16(88.9) 2(11.1) 部分无张FN前移位 18 16(88.9) 2(11.1) 
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