lateral skull base tumor
Introduction
Introduction to lateral skull base tumor The lateral skull base tumor (tumorsofthelateralskullbase) mainly includes jugular spheroid tumor, carotid body tumor, nasopharyngeal carcinoma, nasopharyngeal angiofibroma, middle ear cancer, acoustic neuroma, giant cell tumor of the tibia and blastoma, meningioma, and parotid gland. Tumors and slope chordomas, etc. The lateral skull base is composed of six compartments, such as the joint area of the auditory canal area and the infraorbital area of the eustachian tube area of the pharyngeal area. The tumors that invade the lateral skull base are collectively referred to as lateral skull base tumors. Lateral skull base tumors occur in middle-aged women and grow slowly. There is a tendency to have a family, which can be bilateral. Because it usually originates in the middle ear, early symptoms of middle ear occur. The lesions go beyond the middle ear cavity and can compress the cranial nerve adjacent to the jugular vein. The corresponding symptoms and signs appear. 1, pulsating tinnitus. 2. Hearing impairment. 3, external auditory canal examination, when the periosteum is intact, visible red or blue swelling on the lower part of the shadow, sometimes push the lower part of the tympanic membrane, and there are beats. When pressurized with a otoscope, the tympanic membrane became white and the pulsation disappeared. 4, ear leaks. 5, jugular foramen syndrome. basic knowledge The proportion of sickness: 0.0023% Susceptible people: no specific people Mode of infection: non-infectious Complications: olfactory disorders
Cause
The cause of lateral skull base tumor
The tumor originates from the jugular vein or the glossopharyngeal nerve, forming a vascular granulation tissue with an envelope, a dark red color, a smooth surface or a slight nodule, which is surrounded by a polygonal epithelioid cell mass under the microscope. Thin-walled blood vessels, blood vessels without contraction function are easy to hemorrhage, tumor cells vary in size, cytoplasm is rich, nuclear ellipse, no division, negative chromaffin reaction, a small amount of lymphocytes, fibroblasts and elastic fibers between tumor cells. Tumor growth is slow, can spread to adjacent tissues, involving the external auditory canal, middle ear mastoid, rock tip and can enter the middle or posterior fossa, a small number of malignant metastases.
Prevention
Lateral skull base tumor prevention
Points to note for postoperative care of skull base tumors:
1. Pay close attention to possible complications:
a. Patients with anterior cranial fossa tumors may experience olfactory loss and cerebrospinal fluid rhinorrhea after resection.
b. Patients with cavernous sinus tumor may have symptoms of numbness, abduction nerve and other paralysis after surgery.
c. Cerebellar pons and jugular vein area tumor patients may have trigeminal nerve, facial nerve, auditory nerve damage after resection, dysphagia, cough and other symptoms of the cranial nerve.
d. Symptoms of typical respiratory dysfunction may occur after surgery on the slope and occipital macropore.
Experts reminded that for the complications that have already occurred, we must take targeted treatment methods, strengthen nursing measures, and apply active treatment such as neurotrophic drugs.
2. Patients with skull base tumors were re-extracted from the tracheal intubation when cough reflex was found after the surgery was completely awake. If the symptoms of the posterior cranial nerve dysfunction are obvious, tracheotomy should be actively performed. If the breathing is found to be irregular, the tidal volume is insufficient to apply the ventilator to assist the patient in breathing.
3, for tracheotomy patients try to block the tube, should be carried out in the patient's consciousness, breathing is stable and cough reflex is obvious, body temperature is normal. If there is no abnormality after the tube is blocked one day, the tube can be removed. Regardless of whether there is a tracheotomy, as long as the patient is more or more thick, he should take inhalation, and turn over the back to help with drainage. These measures are taken to ensure the patient's airway is unobstructed.
4. At the time of discharge, the attending doctor should clear the precautions for discharge to the patient and his family, and review the magnetic resonance imaging for 3 months.
Complication
Lateral skull base tumor complications Complications olfactory disorders
1. There may be olfactory loss and cerebrospinal fluid rhinorrhea in the skull base tumor.
2, cavernous sinus tumor may appear oculomotor, abductor nerve and other paralysis.
3, cerebellum pons and jugular vein area tumors may appear trigeminal nerve, facial nerve, auditory nerve damage and dysphagia, cough and other symptoms of the cranial nerve.
4, slope and occipital macropore area tumor may appear respiratory dysfunction after surgery.
Symptom
Symptoms of lateral skull base tumor Common symptoms Bloody pus nose, nasolacrimal duct obstruction, ear swelling, pulsating tinnitus, otogenic vertigo, conductive deafness, tinnitus
Those who are confined to the tympanic cavity in the early stage may have beating tinnitus consistent with the pulse, progressive conduction sputum and fullness in the ear. Compression of the ipsilateral neck blood vessels may temporarily weaken or disappear the tinnitus. The otoscopy is faintly visible through the tympanic membrane. The lower part has a red shadow. If it is pressurized with a otoscope, the tympanic membrane pulsates when the tympanic membrane is in contact with the tumor. The red color becomes lighter. When the tumor enlarges and ruptures the tympanic membrane, a dark red polyp is seen in the deep part of the external auditory canal. Bloody or purulent secretions. Invasive invading can cause sensorineural paralysis, dizziness or peripheral facial paralysis. Tumors invading the jugular foramen and surrounding bone can cause neurological damage in IX, X, and XI, and invade the tip of the rock into the cranial fossa. There may be symptoms such as the damage of the cranial nerves of the V and VI, the stimulation of the meninges and the increase of the internal pressure of the neck. The tumor spreads to the neck, and there is a volatility in the mandibular angle.
Most of the surgical treatment of lateral skull base tumors occurs after birth, 90% occur before the age of 2, and fewer occur after the day. Mostly located in the posterior triangle of the neck, the size of the cyst is different. When it is small, it is asymptomatic and not found. When it is large, it can occupy the entire neck, up to the cheek and parotid area, and forward beyond the midline of the Jingjing, down to the collarbone. Lower nest and nickel I, back to the shoulders. The cyst is soft, elastic, mostly multi-atrial, the wall of the capsule is very thin, the capsule is clear liquid, and the light transmission test is positive. Although the cyst is very large, there is little compression symptoms except for a slight restriction on head and neck activity. In the case of secondary infection or intracapsular hemorrhage, the cyst rapidly increases and may be associated with local pain.
The typical symptoms are mainly related to the area of tumor invasion. There may be nasal obstruction and pus and blood stasis in the pharyngeal area. Invading the eustachian tube area may have ear occlusion or suffocation and hearing loss. After venous syndrome involving the cerebral nerve, if the hypoglossal canal is invaded, there may be atrophy of the ipsilateral lingual muscles and the tongue is biased toward the affected side. Invading the auditory canal, there are many tinnitus hearing loss, ear discharge, bloody secretions and facial paralysis. The level of the joint area is mainly characterized by local bulging and opening of the mouth. Invasion of the infraorbital area may treat numbness and headache only in the mandibular area.
The surgical responsibility of the sinus resection of the lateral skull base tumor can only have the infraorbital fossa approach and the middle skull base approach, and the infraorbital fossa approach can expose the internal carotid artery in the rock bone to facilitate the control of venous sinus bleeding. According to the lesion site, the facial nerve can be diverted to facilitate the open approach and prevent facial nerve injury. It is suitable for invading the pharyngeal eustachian tube area and the neurovascular area. The middle skull base approach is suitable for invading the joint area and armpit of the auditory canal. Tumors in the area.
The division of the skull base has not yet been unified. The so-called lateral skull base refers to the center of the sinus pharyngeal wall, and the front and the outer pterygopalatine fossa reach the anterior humeral anterior cleft, and the posterior transcranial fossa is between the two hypothetical lines. The triangular region, which includes the internal carotid artery hole, the jugular foramen, the foramen ovale, the spine, the stem and the cranial nerve and blood vessels that pass through each hole, and the temporomandibular joint, the eustachian tube bone, etc. Common tumors in the lateral skull base area include nasopharyngeal carcinoma, middle ear cancer, auditory nerve and facial nerve sheath tumor, meningioma, teratoma, and congenital cholesteatoma. Among them, the important and complicated one is jugular spheroid tumor. Jugular spheroid tumor, also known as glomus tumor, is a benign midstream of women with multiple middle-aged and above, and has a family-like tendency.
Examine
Examination of lateral skull base tumor
(1) Head ct and mri examination: Identify the tumor site.
(2) vascular microscopic examination: skull base tumor blood supply is rich or closely related to the internal carotid artery and other aorta, should be a whole brain dsa examination, can also be cta check, understand the main blood supply artery and drainage vein, pay attention to whether the tumor Wrapped larger blood vessels.
(3) According to the skull base tumor site before surgery, visual field of vision, electrical audiometry and brainstem evoked potential examination.
Diagnosis
Diagnosis and diagnosis of lateral skull base tumor
Typical symptoms and signs are the basis for diagnosis. X-ray humeral tomography and retrograde jugular venography can help determine the location and extent of destruction of the tumor. Selective carotid angiography, digital subtraction angiography can show the blood supply of the tumor. CT and MRI are useful for judging whether there is intracranial invasion. To avoid major bleeding, biopsy should be extremely careful. The disease must be differentiated from ear polyps, cholesterol granuloma, idiopathic blood tympanic, middle ear hemangioma, middle ear cancer, meningioma, IX, XII, neurofibroma of the cranial nerve, and high jugular spheroid.
Children with lateral skull base tumors are rare in clinical practice, and there are major difficulties in diagnosis and treatment. Types of lateral skull base tumors in children include acoustic neuroma and neurofibromatosis type II, meningioma, congenital cholesteatoma, rhabdomyosarcoma, chordoma and chondrosarcoma, teratoma, myxoma, lipoma and other tumors; surgery The path includes the posterior sigmoid sinus path, the transcranial-eyelid-ankle arch path, the transorbital path, the meridian path, the transaeral approach, the transcranial fossa, and the inferior fossa. The authors reviewed the above to improve their understanding of clinicians.
The incidence of lateral skull base tumors in children is low, and there are few reports on such diseases in domestic and foreign literatures. However, because of its special location, the skull base tumor has a very close relationship with important structures such as cranial nerve, important blood vessels and brain tissue, and the anatomical structure is complex, the position is deep, the treatment is difficult, and the surgical trauma is large. Therefore, whether it is a benign or malignant tumor, once it is involved in this area, it may cause serious trauma to the body.
