鼻咽癌颅底骨受累与头痛和颅神经症状的关系
中华放射肿瘤学杂志 2000年第3期第9卷 论 著
作者：陆进成 张宜勤 魏宝清
单位：陆进成 张宜勤 魏宝清（210009 南京, 江苏省肿瘤医院放射治疗科Email:CHRTLUJC@public1.ptt.js.cn）
关键词：鼻咽肿瘤； 颅底骨侵袭； 磁共振成像
【摘要】 目的 探讨鼻咽癌颅底骨受累与头痛和颅神经症状的关系。方法 对经病理证实行首程放射治疗并做MRI检查的鼻咽癌患者128例,通过MRI检查结果分析鼻咽癌颅底骨受累与头痛和颅神经症状的关系,并推断其发生时间。结果 鼻咽癌颅底骨受累的发生率为75.8%(97/128),破坏部位以斜坡最为常见,占81.4%(79/97), 破坏的斜坡脑面出现硬膜强化增厚(硬膜尾征)占16.4%(21/128),6例放射治疗后0～14个月复查MRI,强化增厚的硬膜全部恢复正常或明显变薄。 头痛发生率为57.0%(73/128),以颞、额部最为常见,占56.2%(41/73); 颅神经症状阳性率为41.4%(53/128),以第Ⅴ对最为常见,占84.9%(45/53)。头痛、颅神经症状阳性及两者均出现的颅底骨受累发生率分别为94.5%(69/73)，92.5%(49/53)，97.6%(41/42)。在颅底骨受累的病例中,头痛、颅神经阳性及两者均出现者分别占 71.1%(69/97)，50.5%(49/97)，42.3%(41/97)。上述两类症状出现2个月以上者颅底骨100.0%(35/35，13/13)受累,无症状的颅底骨受累发生率为45.5%(20/44)。结论 头痛和颅神经症状可能是鼻咽癌颅底骨受累的重要指征。
Relationship between skull base infiltration and headache or cranial nerve palsy in nasopharyngeal carcinoma
LU Jincheng，ZHANG Yiqin，WEI baoqing(Department of Radiation Oncology, Jiangsu Cancer Hospital, Nanjing210009,China)
【Abstract】 Objective To establish the dependence of headache and/or cranial nerve palsy(CNP) on skull base infiltration(SBI) in nasopharyngeal carcinoma(NPC). Methods From March1993 to December 1998, 128 patients with NPC received initial radiotherapy. All were diagnosed histologically and confirmed to have SBI by MRI. Analyses of the onset time and relationship between headache or CNP and SBI were performed. Results Incidence of SBI in NPC was 75.8%(97/128). The most common site of bony erosion was basilar clivus with a frequency of 81.4%(79/97).16.4% (21/128) manifested itself as dural tail signs of clivus infiltration on the side close to brain.In six of them,the involved dura mater was normalized or thinned obviously,as shown by MRI after radiotherapy(0～14 months). The incidence of headache was 57.0%(73/128). frontotemporal headache was most common in 56.2%(41/73). The incidence of CNP was 41.4%(53/128) with the fifth cranial nerve involved most commonly in84.9%(45/53). Incidences of headache or CNP both in SBI were 94.5%(69/73),92.5%(49/53) and 97.6%(41/42), respectively. In the case of SBI, the frequencies of headache CNP or both were 71.1%(69/97), 50.5%(49/97) and 42.3%(41/97), respectively. 100% (35/35,13/13) of patients with the aforementioned symptom lasting over two months were demonstrated as having SBI,whereas asymptomatic SBI was found in 45.5%(20/44) patients. Conclusion Headache and cranial nerve palsy are considered as the major indicators of skull base infiltration in NPC.
【Key words】 Nasopharyngeal neoplasms; Skull base infiltration; Magnetic resonance imaging
已知鼻咽癌颅底骨受累的诊断MRI明显优于CT［1-6］。但对