显微外科治疗听神经瘤及桥小脑角病理解剖观察

The microsurgical therapy on Neurinoma and the observation on pathological cmatomy of CPA

目的探讨患听神经瘤的显微外科治疗桥小脑角局部病理解剖,确定肿瘤和桥小脑角的结构相互关系,阐明肿瘤切除时发生并发症的原因及预防方法。方法回顾性分析我科显微手术治疗的48例听神经瘤的临床资料,重点分析肿瘤的血供来源、与颅神经及血管、重要结构等的解剖关系。结果小脑前下动脉是听神经瘤主要供血来源(48例),少部分肿瘤由小脑后下动脉和小脑上动脉参与供血(5例),1例由基底动脉发出分支参与供血;小脑大前静脉是肿瘤的引流静脉,主要经岩静脉回流至岩上窦;面神经位于肿瘤的腹侧36例(其中上部8例,中部22例,下部6例)、肿瘤上极3例、肿瘤下极5例、肿瘤背侧3例(其中上部2例,下部1例),位于瘤内1例;三叉神经和滑车神经均位于肿瘤的上极或前上方;IX、X、XI颅神经位于肿瘤的下极或下外侧。结论患听神经瘤时桥小脑角神经血管的正常解剖关系发生了不同程度的变化,掌握这些神经血管位置的变化,对于保留神经血管功能、减少术后并发症具有重要的意义。

Objective To explore the pathological anatomy and clinical significance of CPA in patients with acoustic neurinoma by microsurgical therapy, ascertain the relationships between tumor and adjacent neurovascular structures and clarify the reason and prevention of post - operational complications when removing tumors. Methods The clirical data of 48 cases with acoustic neurinoma in our department were retrospectively analyzed, mainly including the source of blood supply of these tumors, the topographic relationship between tumors and vital structures（such as cranial nerves,vessels and so on）. Results The blood supply of acoustic neurinoma mainly originated from the branches of the anterior inferior cerebellar artery in all cases,and the branches of posterior inferior cerebellar artery,superior cerebellar artery （5 cases）,and basilar artery（only 1 case） were also involved; The tumors were mainly drained into superior petrosal sinus by great anterior cerebellar vein and petrosal vein ; Facial nerves largely located in the belly side（36 cases intotal, anterior - superior 8 cases, anterior - middle 22 cases, anterior - inferior 6 cases）, in 3 cases the nerves were displaced to the superior pele,5 cases to the inferior, in 3 cases the nerve were found at the dorsal aspect of tumor （superior 2 cases and inferior 1 case） ,and only in 1 case, the nerve went through the tumor;cranial nerves V and IV were located to the superior pole or anterior- superior of tumors;cranial nerves IX,X,XI to the interior pole or inferior- outside. Conclusion In acoustic neurinoma patients, the normal anatomy relationship of nerves and vessels in CPA varies in a certain degree. A good understanding of pathological microanatomy of tumor, as well as its relationship with adjacent neurovascular structures, will greatly benefit to preserve the neurovascular function and reduce the post - operational complications.