大型听神经瘤的显微手术

Microsurgical treatment of large acoustic neuromas

目的报道大型听神经瘤显微手术切除、面神经解剖保留及功能恢复的临床效果。方法采用枕下乙状窦后入路切除大型听神经瘤82例，并将术后面神经功能HB分级为Ⅲ～Ⅵ级者随机分为2组，分别予Kabato康复训练和常规治疗．对其临床资料进行回顾性总结。结果肿瘤全部切除77例（93．9％），次全切除5例。面神经解剖保留78例（95．1％），术后训练组面神经功能恢复较快，且显效率和有效率均明显高于非训练组。随访6个月～3年，次全切除5例中复发2例，3例患者出现慢性头痛，无长期昏迷、死亡病例。结论全切除肿瘤的同时保留面神经功能，是大型听神经瘤显微手术的目标。

Objective To explore the skill of microsurgical removal and preservation and functional recovery of facial nerve for large acoustic neuromas. Methods The clinical data of 82 consecutive patients with large acoustic neuromas operated upon through the suboccipital retrosigmoid approach were retrospectively reviewed. The cases with HB grade Ⅲ- Ⅵ of facial nerve were divided randomly into two groups, the one group was given conventional therapy and the other group was given Kabato rehabilitation training. Results In those cases,acoustic neuromas were totally removed in 77 （93.9%）, subtotally removed in 5. Facial nerve was kept anatomically intact in 78 cases of the patients （95.1%）. Recovery of facial nerve function was faster and more effective in the training group than that in the un-training group. During the follow-up ranging from 6 months to 3 years, among 5 cases of subtotally resection, 2 cases relapsed. Three patients in our series complained of chronic headache postoperatively. No patient long time coma or died. Conclusion The goal of large acoustic neuromas treatment should be total removal in one stage and preservation of facial nerve function,as they determine a patient＇s quality of life. Kabat rehabilitation training is the effective method of functional recovery of facial nerve after operation.