巨大听神经瘤显微外科治疗策略

Strategy of microsurgical treatment for huge acoustic neuromas

目的总结165例巨大听神经瘤显微手术治疗效果,探讨巨大型听神经瘤显微手术治疗策略。方法165例巨大听神经瘤均采用枕下乙状窦后经内听道入路,在神经电生理监护下行显微手术切除肿瘤,术后随访时间6个月-4.5年。结果肿瘤全切151例（91%）;近全切除14例（8.4%）。术中面神经解剖保留149例（90.3%）,功能保留95例（57.2%）。结论巨大听神经瘤手术治疗是首选的治疗方法。根据术前和术中的策略,在术中神经电生理监测条件下,运用娴熟的显微外科技术可以提高巨大听神经瘤的切除率、面听神经的保留率。

Objective To summarize the experience of microsurgical treatment and discuss the strategy of microsurgical treatment for the 165 large acoustic neurilemomas.Methods 165 patients with huge acoustic neurilemoma were treated by microneurosurgery,during which facial nerve monitoring was performed,via suboccipital retrosigmoid and transmeatal approach.All the patients were postoperatively follow up for 6 months to 4.5 years.Results Of 165 cases of the large acoustic neuromas,151 were totally removed（91%）,14 subtotally（8.4%）.Facial nerves were kept anatomic intact completely during the operation in 149 patients（90.3%）,and the facial nerve function was preserved in 95 patients（57.2%）with the huge acoustic neuromas.Conclusion Microsurgery treatment is the best choice for the huge acoustic neuromas.On the basis of strategies before and during the operation,the excellent microneurosurgical technique could improve the rate of resection and the rate of keeping facial nerve intact with effective nerve monitoring.