显微切除听神经瘤与面神经保留技术的探讨(附60例报告)

Microsurgicai treatment of acoustic neurilemoma and facial nerve preservation

目的探讨听神经瘤显微手术中面神经的保留。方法对59例听神经瘤病人采用枕下乙状窦后入路,1例经迷路入路,开颅进行显微手术治疗,肿瘤最大径6.2cm×6.0cm,术中注意肿瘤与蛛网膜边界,并沿该边界分离并分块切除肿瘤,锐性分离面神经与肿瘤的界面;磨开内听道,神经内镜辅助下切除内听道内肿瘤。注意保护面神经的滋养血管,如面神经与肿瘤包膜粘连紧密,则不强求全切除肿瘤;同时注意保护小脑前下动脉、小脑后下动脉、岩静脉、后组颅神经及脑干。结果肿瘤全切除57例,次全切除3例,面神经解剖保留率为83.3%,手术死亡1例。术后一周面神经功能House-Brackmann分级[1]:Ⅳ级31例,Ⅲ级19例,Ⅱ级9例,Ⅰ级1例。术后一年随访,肿瘤均无复发。结论显微外科技术能有效地全切除肿瘤,大大提高了面神经的保全率,做到微创、减少并发症。

Objective To study the facial nerve preservation during microsurgical treatment of acoustic neuri lemoma. Methods Using suboccipital retrosigmoid keyhole approach, 60 patients with acoustic neuroma were treated microsurgically. The biggest tumor was 6.2-6.0 cm in diameter. Carefully expose the connexion of transverse sinus and sigmoid sinus, dissecting the facial nerve from the tumor, and then the internal auditory meatus was drilled open and the residue tumor removed via microsurgery equipments. Focus on protecting the medullary artery of facial nerve. If facial nerve is integrated closely with tumor, don＇t wholly remove it by force. Results Total tumor resection was achieved in 57 patients, with vice-total tumor resection achieving in 3 patients. Anatomical facial nerve preservation rate was 83.3%, 1 patient died in the operation. After the operation makes a follow-up visit, seldom did the tumor recur. Patients with House-Brackman grade Ⅳ, Ⅲ , Ⅱ and Ⅰ were 21, 19, 8 and 1 respectively. Conclusion The microsurgery technology could effectively approach the total excision tumor, greatly enhance facial nerve preserving rate, achieved microdamage, reduces the illness complication.