显微手术切除听神经瘤并面听神经功能保护

Microsurgical treatment of acoustic neuroma with facial and acoustic nerve preservation

目的探讨显微手术切除听神经瘤并面听神经功能保护的疗效,总结临床经验。方法回顾性分析我院1996年—2005年20例经枕下乙状窦后内听道入路手术切除听神经瘤的临床资料,均使用显微外科技术保留面听神经功能。结果听神经瘤手术全切除19例(95%),次全切除1例;面神经解剖保留17例(85%),手术后4个月面神经功能保留16例(80%);耳蜗神经解剖保留17例(85%),手术后4周有效听力保留10例(占术前存在有效听力患者的50%),有效听力丧失但可测听力保留10例;无1例死亡。结论枕下乙状窦后经内听道入路的听神经显微手术,能够取得较好的肿瘤全切除率和面听神经功能保留率,是一种较理想的治疗方案。

Objective To observe the microsurgical effects of acoustic neuroma with facial and acoustic nerve preservation and to summarize the clinical experience. Methods 20 patients of acoustic neuroma was microsurgicallyresected, their facial and acoustic nerve was preserved at the same time. Results Among the 20 patients, acoustic neuroma was completely removed in 19 patients （95%） and subtotally removed in 1 patient. Facial nerve was preserved anatomically in 17 patients （85）, and functionally in 16 patients （80%） after 16 weeks postoperatively. Cochlear nerve anatomic was preserved in 17 patients （85%） during operation. An ditognosis was presented in 10 patients after 4 weeks postoperatively （account for 50% of all patients with useful hearing preoperatively）, measurable but not useful hearing preservation was in 10 patients. No intraoperative death occurred, Conclusion Undergoing rctrosigmoid approach one can succeed to get high rate of total acoustic neurorna removal, facial and hearing preservation. This is an ideal treatment for acoustic neuroma.