扩大迷路进路大型听神经瘤切除术脑脊液漏防治

Preventive management of cerebrospinal fluid leakage in the removal of large acoustic neuromas by enlarged translabyrinthine approach

目的探讨扩大迷路进路行大型听神经瘤手术脑脊液漏的预防和治疗,分析原因,以降低其发生率。方法本组42例均经扩大迷路进路行大型听神经瘤手术,切除肿瘤后,分别采用缝合外耳道、封闭咽鼓管、脂肪填塞术腔、带蒂枕肌瓣转移填塞术腔等方法预防脑脊液漏。结果术后6例出现脑脊液漏,保守治疗无效后,经手术修补治愈。随访1年以上无复发。结论扩大迷路进路听神经瘤手术脑脊液漏防治术中处理是关键,术后以先保守治疗后手术为宜。

Objective To investigate the preventive managemnet of cerebrospinal fluid leakage in the removal of large acoustic neuromas by enlarged translabyrinthine approach. Methods The removal of large acoustic neuromas by enlarged translabyrinthine approach in 42 cases, the operative cavity was closed by obstruction of eustachian tube and the external auditory meatus. Results Total tumor removals were achieved in 42 patients. There were cerebrospinal fluid leaking in 6 cases. First nonsurgical treatment, cure by surgical treatment. The patients were followed for more than a year. There was no local and intracranial infection. Conclusion The treatment of the operative cavity is important in the preventive management of cerebrospinal fluid leakage in the removal of large acoustic neuromas by enlarged translabyrinthine approach.