显微外科手术治疗巨大听神经鞘瘤(附32例报告)

Microsurgical treatment of large acoustic neurilemoma(report of 32 cases)

目的 探讨巨大听神经鞘瘤显微外科手术的方法、疗效及并发症的预防。方法 回顾性分析32例巨大听神经鞘瘤的显微外科手术情况。结果所有病例均通过枕下乙状窦后入路显微外科手术切除。肿瘤全切除（SimpsonⅠ～Ⅱ级）30例（93．8％），次全切除（Simpson Ⅲ级）2例。面神经解剖保留19例（59．4％），按House-Brackmann标准，面神经功能工级9例（28．1％）。Ⅱ～Ⅲ级13例（40．6％），Ⅳ级以上8例（25．0％）；死亡1例。结论 熟练的显微外科手术技术能使巨大听神经鞘瘤获得良好的全切除率，巨大听神经鞘瘤的面神经解剖及功能保留尚有难度，需进一步改善提高。

Objective To discuss the microsurgical treatment method, curative effect and the complication prevention for large acoustic neurilemoma. Methods The microsurgical situation of 32 patients with large acoustic neurilemoma were summarized and analyzed. Results The suboccipital retrosigmoid transmeatal approach was used in all cases to remove the tumors with microsurgery. The tumors were total removed （Simpson Ⅰ-Ⅱ grade） in 30 cases （93.8%）, inferior total removed （Simpson Ⅲ grade） in 2 cases. The facial nerve was preserved anatomically in 19 cases （59.4%）. According to the House-Brackmann standard, the facial nerve function was retain grade I in 9 cases （28. 1% ）, grade Ⅱ-Ⅲ in 13 cases （40.6%） and grade Ⅳ above in 8 cases （25.0%）. One died. Conclusion The skilled microsurgical technique can cause large acoustic neurilemoma to obtain the high total excision rate, increasing the facial nerve anatomieal and functional preservation still have difficulty.