乙状窦后径路听神经瘤切除术中内镜辅助应用价值的探讨

Application of the endoscope assisting in retrosigmoid approach vestibular schwannoma resection

目的:探讨内镜辅助在行乙状窦后径路听神经瘤切除术中的应用和意义。方法:在内镜辅助下经乙状窦后径路听神经瘤切除术12例,术中行面、听神经监测,手术前后面听功能评估,并与未采用内镜辅助的乙状窦后径路手术进行综合比较。结果:12例听神经瘤完全切除,手术完成顺利,术后无并发症。术中面听神经均获解剖保留,术中神经监测以观测面听神经功能保留情况,术后半年面神经功能与术前相比无明显改变,所有患者听觉功能与术前相比均有不同程度下降。内镜辅助下手术组术后面神经功能及听觉功能改变与未采用内镜辅助手术组差异无统计学意义。结论:在乙状窦后径路手术中应用内镜辅助能为桥小脑角区手术提供精确的信息,在避免后半规管、颈静脉球损伤的前提下,完全切除内耳道底的肿瘤,减少并发症的发生,但对面听神经功能保留无明显作用。

Objective： To explore application of endoscope assisting in retrosigmoid approach vestibular schwannoma resection and its signification. Method：Through retrosigmoid approach with endoscope assisting, vestibular schwannoma in the cerebellopontine angle was removed in 12 cases. Assessment of function of facial nerve and auditroy was made for all patients preoperative and postoperative. Result： Vestibular schwannoma in 12 patients were removed completely, then the facial nerve and the acoustic nerve were preserved after tumor removal. No complication was found in six months. We observed the hearing loss in postoperative patients; and there is no difference in facial nerve function between preoperative and postoperative. The alteration of auditory and facial nerves functions is no difference between two retrosigmoid approach groups with or without endoscope assisting. Conclusion： Application of endoscope assisting in retrosigmoid approach can be helpful for totally resection of vestibular schwannoma in inner acoustic meatus without lesion of canalis semicircularis and glomus jugulare. Application of the endoscope assisting in retrosigmoid approach is helpful to provide the precise information of CPA ana-tomic structure and decrease the incidence rate of complication.