大型听神经瘤的术中面神经保护(附38例分析)

Facial nerve preservation in microsurgery for large acoustic neuroma: report of 38 cases

目的总结显微外科技术与电生理监测技术在大型听神经瘤显微切除术中的经验。方法回顾性分析38例大型听神经瘤的临床资料。术前面神经功能House-Brackmann分级(H-B分级):Ⅰ～Ⅱ级36例,Ⅲ～Ⅳ级2例。结果肿瘤全切除33例,次全切除5例;术中面神经解剖保留32例,术后死亡1例。出院时面神经功能H-B分级:Ⅰ～Ⅱ级28例,Ⅲ～Ⅳ级6例,Ⅴ～Ⅵ级3例。结论应用显微外科技术与电生理监测技术可明显提高大型听神经瘤显微切除术的疗效。严格保持肿瘤表面蛛网膜的完整性是保留面神经功能的关键。术中尽量重建断裂的面神经,对术后神经功能恢复有一定帮助。

objective To summarize the experience with microsurgical techniques and electrophysiological monitoring in patients with large acoustic neuroma. Methods Clinical data of 38 patients with large acoustic neuroma were retrospectively analyzed. Facial nerve function was assessed by House-Brackmann （H-B） scale before the operation： class Ⅰ - Ⅱ in 36 cases and class Ⅲ-Ⅳ in 2. Results Total tumor resection was achieved in 33 cases, subtotal resection in 5, and preservation of facial nerve in 32. One patient died, and other patients were assessed by H-B scale at discharge： class Ⅰ - Ⅱ in 28 cases, class Ⅲ-Ⅳ in 6 and class Ⅴ-Ⅵ in 3. Conclusion The micro-surgical and electrophysiological monitoring technologies could obviously improve the operative effects. The key point of facial nerve preservation was to keep the integrity of arachnoid on the tumor surface. Reconstruction of the ruptured facial nerve might be helpful to recover the neurofunction.