听神经瘤合并脑积水的治疗

Treatment of acoustic neuroma combined with hydrocephalus

目的探讨听神经瘤合并脑积水的治疗方案。方法回顾性分析21例听神经瘤合并脑积水病人的临床资料,均采用枕下乙状窦后入路切除听神经瘤;脑积水行脑室外引流术、脑室-腹腔分流术或保守治疗。结果听神经瘤均达全切除;肿瘤切除后脑室缩小10例,肿瘤切除加脑积水手术后脑室缩小5例,随访期间脑室缩小3例,脑室无明显缩小3例。听神经瘤切除后出现颅内血肿2例,均行急诊脑血肿清除术。结论听神经瘤合并脑积水应优先治疗听神经瘤,当影响肿瘤切除时先行处理脑积水;根据病人术后症状谨慎选择脑积水手术治疗;脑积水分流手术前需要排除术后脑水肿的影响;涉及脑脊液操作时注意缓慢及梯度降压。

Objective To explore the therapeutic method for acoustic neuroma combined with hydrocephalus.Methods Clinical data of 21 patients with acoustic neuroma and hydrocephalus were analyzed retrospectively.Acoustic neuroma was resected through retrosigmoid sinus approach,and hydrocephalus was treated with ventricular drainage,ventriculoperitoneal shunt or conservative treatment.Results Total acoustic neuroma resection was achieved in all the patients.The ventricles shrank in 10 patients after tumor resection,the ventricles shrank in 5 after tumor resection and hydrocephalus operation,and the ventricles shrank in 3 and no obviously changed in 3 during the follow-up period.Intracranial hematoma occurred in 2 patients after tumor resection,and was treated by emergency hematoma removal.Conclusions Acoustic neuroma should be treated first for acoustic neuroma combined with hydrocephalus,while hydrocephalus should be treated first when tumor resection cannot performed normally.Surgical treatment of hydrocephalus should be selected carefully according to postoperative symptoms of patients.The influence of postoperative cerebral edema should be excluded before shunt operation for hydrocephalus,and more attention should be pay to slowing and gradient depressurization of cerebrospinal fluid operation.