乙状窦后入路显微手术切除大型听神经瘤的临床研究

Microsurgical resection of large acoustic neuroma through the retrosigmoid approach： a clinical analysis

目的探讨经乙状窦后入路显微镜下切除大型听神经瘤的手术技巧，减少神经损伤和并发症。方法采用经乙状窦后入路显微手术切除大型听神经瘤21例，对肿瘤暴露、显微手术技巧、手术中特殊情况及并发症进行分析。结果肿瘤全切除18例，次全切除3例，面神经功能保留17例，听力保留5例。术中出现心跳短暂停止1例，术后短期并发症4例，无死亡病例。结论经乙状窦后入路显微镜下的切除大型听神经瘤是安全的手术方法，良好的手术技巧、对解剖的熟悉是全切肿瘤、减少神经损伤和并发症的关键。

Objective To discuss the surgical skills in microsurgical resection of large acoustic neuromas via the retrosigmoid approach for reducing the neural damage and complications of such surgeries. Methods Twenty-one cases of large acoustic neuroma treated with microsurgery via the retrosigmoid approach were retrospectively analyzed in view of the surgical approach, microsurgical techniques, intraoperative accidents, and management of the postoperative complications. Results The tumors were totally removed in 18 cases and subtotally in 3 cases. The facial nerve function was well preserved in 17 cases （80.9%）, and the acoustic nerve was preserved in 5 cases （23.8%）. Intraoperative cardiac arrest occurred in 1 case, and 4 patients developed short-term postoperative complications, but no deaih occurred in these cases. Conclusion Microsurgical resection through the retrosigrnoid approach is safe for removal of large acoustic neuroma, and proficient microsurgical skills and thorough understanding of the microanatomy are crucial for total tumor resection and reduction of the nerve injuries and surgical complications.