巨大听神经瘤手术中面神经的保护

Facial Nerve Reservation in Large Acoustic Neuroma Surgery

目的:探讨和分析巨大听神经瘤手术面神经保留技术。方法:在面神经监护的条件下,57例巨大听神经瘤病人,采用枕下乙状窦后入路,显微外科切除肿瘤。术中观察肿瘤与面神经的病理解剖关系,术后随访时间6个月至5年。结果:肿瘤全切除54例(94.7%),次全切3例(5.3%)。面神经解剖完整保留52例(91%),面神经解剖部分保留5例(9%)。结论:在有效的术中面神经功能监测条件下,出色的显微外科技术以及对面神经解剖关系的充分认识是面神经解剖保留的基础。识别不与肿瘤粘连的面神经脑干端或内听道端,再沿面神经锐性分离肿瘤,是面神经解剖保留的技术关键。

Objective：To summarize and analysis the skills of facial nerve reservation in large acoustic neuroma surgery.Methods：Fifyty-seven patients with large acoustic neuroma were operated via suboccipital retrosigmoid transmeatal approach for reserving facial nerve.The pathological-anatomic relationships of tumor and facial nerve were studied,accompanied with nerve monitoring.Postoperative following up had continued from 6 months to 5 years.Results：Total tumors resection was achieved in 54 patients（94.7%）,subtotal in 3 patients（5.3%）.Facial nerves was kept anatomic intact completely in 52（91%）of the patients and anatomic intacat partially in 5 patients（9%）.Conclusions：With effective nerve monitoring,the excellent microneurosurgical technique and the familiarity to facial nerve anatomy are essential.It is key skill for keeping facial nerves anatomic intact to identify brainstem segment and intrameatus segment of facial nerves,which is usually not stick on tumor,then separate the tumor along the nerve.