大型听神经瘤的手术治疗

Surgery of huge acoustic neurinoma

报告１９９１年１月至１９９４年１２月手术切除的大型听神经瘤１４０例，无术后死亡。肿瘤全切除率８４．３％，面神经保留率８７．３％，术前有听力者听神经保留率６４．１％。绝大多数（９６％）的病例采用一侧枕下乙状窦后入路，作者总结了肿瘤全切除和保留面神经的经验，同时强调手术前后处理也至关重要。（１）危重患者可先行侧脑室－腹腔分流缓解颅压后再开颅手术；（２）术后密切观察病情变化，及时发现和清除术后血肿；（３）术前有后组颅神经麻痹者术后宜早期做气管切开；（４）伤口局部皮下积液在炎症已控制的情况下可行囊腔－腹腔分流术。

This paper reported 140 cases of huge acoustic neurinoma that operated during Jan. 1991 to Dec,1994.The operative mortality was 0. The total removal rate was 84. 3% and the rate of facial nerve preservation was 64.1%, Unilateral retrosigmoid approach was adopted in 96%.Authors described their experiences of total tumor removial and facial nerve preservation and suggeste that perioperative management is also important: (1) In critical patient, V- P shunt were installed before tumor resection to reduce intracrinial hypertension,(2)Closely observing the patient's condition and promptly evacuating postoperative hematoma if it occurred.(3) When the postrior group of the cranial nerves were damaged. early tracheotomy is indicated.(4)If subcutaneous hydroma was occurred,peritoneal shunt may be used after inflammation was controlled.