大型听神经瘤常见手术并发症及其相关因素分析

Common Complications of Microsurgery through Subocipito-retrosigmoid Approach for Large Acoustic Neuromas and Analysis of Factors Related to Them

目的探讨枕下乙状窦后入路切除大型听神经瘤术后常见的手术并发症及其相关因素。方法对96例大型听神经瘤患者的临床资料及术后随访结果进行回顾性研究。结果96例大型听神经瘤全切88例,次全切除5例,大部分切除3例。面神经解剖保留率92.7%(89/96),死亡4例。术后并发症:患侧听力丧失88例,面神经麻痹47例,脑脊液漏8例,颅内积气14例,颅内血肿6例。结论大型听神经瘤术后并发症的发生率与肿瘤的大小及囊性变、手术体位等有关;术者显微技术熟练程度是影响术后并发症的主要因素。

Objective To explore the common complications of microsurgery through the suboccipito- retrosigmoid approach for the large acoustic neuromas and the factors related to them. Method The clinical data of 96 patients with large acoustic neuromas, who underwent microsurgery through the suboccipito-retrosigmoid approach in our department from 2000 to 2007, were analyzed retrospectively. Results Of these 96 patients, 88 received total removal of tumors, and 5 subtotal and 3 part. Four patients died after the surgery. The anatomic preservation rate of the facial nerve was 92.7% （89/96）. The main postoperative complications included loss of hearing （91.7%, 88/96）, facial paralysis （49.0%, 47/96）, leakage of cerebrospinal fluid （8.3%, 8/96）, intracranial pneumatocele （14.6%, 14/96） and intracranial hemotomas （6.3%, 6/96）. Conclusions The incidence of the complications after the surgery for the large acoustic neuromas is related to the size and cystic degeneration of the tumors, body posture of the patients during the operation and so on. The surgical experience and skills of the operators are the key to decrease in the postoperative complications in the patients with large acoustic neuromas.