经枕下乙状窦后入路切除大型听神经鞘瘤

Trans-suboccipital-retrosigmoid Approach to Resect large Acoustic Neurilemoma

目的 :对比分析肉眼直视手术和显微外科手术切除大型听神经鞘瘤 ,总结大型听神经鞘瘤手术切除、术中功能结构保护。方法 :对 8年来手术治疗的 6 7例大型听神经鞘瘤进行回顾性总结分析 ;其中肉眼直视手术治疗 38例 ,显微外科手术治疗 2 9例。结果 :肉眼直视下肿瘤全切率 2 5 % ;听神经解剖保留 74 % ,功能保留 3% ;面神经解剖保留 5 2 % ,功能保留 35 %。显微外科手术全切率 98% ;面听神经解剖保留 89% ,听神经功能保留4 7% ,面神经功能保留 72 %。结论 :枕下乙状窦后入路切除大型听神经鞘瘤是一种安全有效的入路 ;显微外科手术能全切肿瘤 ,绝大部完整保留面听神经解剖结构 ,并最大可能保留面听神经功能。

Objective： Comparative analysis of the excision of large acoustic neurileoma by naked eye and microsurgical technique. To summarize the experience from of operation of large acoustic neurilemoma and its periorperative protection of functional structure during operative. Method： To summarize and analyze the operative treatment of 67 cases of large acoustic neurilemoma, retrospectively; 38 cases were operated by naked eve and 29 cases were accomplished under microscope. Result： Twenty- five percent of tumors were removed completely by naked eye, and 74 percent of acoustic nerves were protected anatomically and 3 percent functionally normal; 52 percent of the facial nerves were protected anatomically and 35 percent functionally normal. Ninty- eight percent of the tumors were removed completely by microsurgical technique, and 89 percent of the acoustic nerves and facial nerves were protected anatomically , and 47 percent of the acoustic nerves were protected functionally; and 72 percent of facial nerve were protected functionally. Conelusion： Trans- suboccipital- retrosigmoid approach to resect large acoustic neurilemoma was safe and effective; complete reseetion of the tumors were possible and protection of the acoustic nerve and facial nerve from operation coud be avoided in most cases.