内镜引导下手术切除内耳道内听神经鞘瘤

Endoscope assisted surgery on acoustic neuroma in internal auditory cannel

目的 探讨内镜技术在切除内耳道（IAC）内听神经鞘瘤术中的价值.方法 对4年来21例听神经鞘瘤患者,进行显微手术切除长入桥小脑角部分的肿瘤后,不磨除IAC后壁而直接采用内镜引导下切除IAC的残余肿瘤.术中在切除IAC内肿瘤前、后刺激IAC口处面神经,记录肌电图.术后1～3个月复查MRI及面神经功能评定,得出IAC内肿瘤全切率和面神经解剖保留率.结果 21例患者IAC内肿瘤全切除18例;IAC段面神经解剖保留16例.全部病例无死亡,无术后脑脊液漏.结论 对IAC明显扩大的听神经鞘瘤患者,采用不磨除IAC骨结构,使用合适的成角手术器械,在内镜辅助下直接切除长入IAC内的肿瘤可获得较好的治疗结果,且可避免术后脑脊液漏等并发症的发生.

[Objective] To evaluate the application of endoscope in acoustic neuroma resection in internal auditory canal（IAC）. [Method] A total of 21 patient with acoustic neuroma and. ICA dilation was studied in the last 4 years. We removed the neuroma that extended into cerebelloponal angel （CPA） under microscope, and the remaining within IAC was resected under endoscope without drilling off the posterior wall of IAC. Facial nerve was stimulated during and after tumor resection and electromyography was recorded. MRI and facial nerve function evaluation was done during 1-3 month after operation to calculate the rate of facial nerve reservation and tumor total resection. [Result] 18 cases reached total resection, and facial nerve was preserved in 16 cases. No patient died or had CSF leakage. [Conclusion] With appropriate angular surgical instruments, endoscopeassisted surgery has been proved to be effective dealing with acoustic neuroma within IAC without removal of the posterior wall that sometimes leads to complications such as CSF leakage.