乙状窦后锁孔入路切除大型听神经鞘瘤

Microsurgical excision of large acoustic neurinomas via retrosigmoid keyhole approach

目的探讨大型听神经鞘瘤经乙状窦后锁孔入路的手术技巧及疗效。方法对16例(17个)大型听神经鞘瘤均行乙状窦后锁孔入路开颅术,术中在神经电生理监护下,通过调节手术床位置和显微镜角度充分显露肿瘤并切除,严密缝合硬膜,骨片复位固定。结果肿瘤全切除14例,次全切除2例;均保留面神经解剖结构。术后出现轻、中度面瘫12例,治疗后改善;残存少许听力5例;切口无皮下积液或脑脊液漏。结论乙状窦后锁孔入路适用于各型听神经鞘瘤,通过调节手术床位置和显微镜角度,均可充分显露肿瘤并全切除。术中神经电生理监护能有效保护肿瘤周围的重要结构。严密缝合硬膜和骨片复位固定可消除局部皮下积液或脑脊液漏。

Objective To explore the surgical skills for and therapeutic outcomes of large acoustic neurinomas via retrosigmoid keyhole approach. Methods Sixteen patients with large acoustic neurinomas underwent craniotomy via retrosigmoid keyhole approach and 17 tumors were removed. The position of the operative bed and the angle of the microscope were adjusted intraoperatively under neuroelectrophysiological monitoring to expose the tumors sufficiently. The dura mater was sutured tightly and the bone flap was replaced and fixed. Results Fourteen cases were removed completely and the other 2 achieved subtotal resection. The facial nerve was anatomically preserved in all the patients. Twelve patients suffered from mild to moderate facial palsy after the surgery, and the symptoms were improved significantly after expectant treatment. Five patients preserved partial hearing. No subcutaneous water accumulation and cerebrospinal fluid leakage occurred. Conclusion Retrosigmoid keyhole approach is suitable for all kinds of acoustic neurinomas. Tumors could be exposed and removed completely by adjusting the position of the operative bed and angle of the operating microscope. The important structures surrounding the tumors could be preserved effectively under neuroelectrophysiological monitoring. Suturing the dura mater tightly and replacing and fixing the bone flap could eliminate subcutaneous water accumulation and cerebrospinal fluid leakage.