枕下乙状窦后锁孔入路显微手术切除听神经瘤的临床观察

Suboccipito-retrosigmoidal keyhole approach for microsurgical resection of acoustic neurinoma

为了总结枕下乙状窦后锁孔入路显微手术切听神经瘤的经验,回顾性分析我院2006-01-2009-04应用枕下乙状窦后锁孔入路显微手术治疗的31例听神经瘤临床资料。单侧耳后6 cm长切口,约3.0 cm×3.0 cm的骨瓣,充分释放小脑延髓池脑脊液后,在减少损伤的前提下切除肿瘤。结果:肿瘤全切除27例,次全切除4例。面神经解剖保留达31例(100%),听力保留24例(77.4%),无死亡病例及严重并发症。初步研究结果提示,枕下乙状窦后锁孔入路创伤小,骨瓣复位,术后并发症少,手术时间短,是显微切除中、小型听神经瘤的一种安全、有效的手术方式。

To objective of this study was to summarize the experience of microsurgical resection of acoustic neurinoma via suboccipito-retrosigmoidal keyhole approach.The clinical data of 31 cases of acoustic neurinoma operated via suboccipito-retrosigrnoidal keyhole approach were retrospectively analyzed in our hospital from January 2006 to April 2009.A small arc incision of 6 cm was made in retroauricular region and the diameter of bone window was about 3.0 cm×3.0 cm.After CSF in the cerebellomedullary cistern released,acoustic neurinoma was excised with little injury.The tumors were totally removed in 27 patients,subtobally removed in 4.Facial nerves of all the patients were preserved anatomically and hearing were preserved in 24（77.4%）.No severe permanent operative complications were found and no surgical mortality occurred.In couclusion,the suboccipito-retrosigmoidal keyhole approach is effective,safe and convenient for the removal of small and medium-size acoustic neurinoma with small invasion,antomical replacement,less postoperative complications and shorting operative time.