枕下乙状窦后小骨窗入路切除听神经瘤62例手术体会

Acoustic neuroma resection through suboccipito-retrosigmoid keyhole approach: experiences of 62 cases

目的总结枕下乙状窦后小骨窗入路切除听神经瘤的手术经验。方法采用枕下乙状窦后小骨窗入路对62例听神经瘤进行手术切除。距乙状窦后缘内侧1.5 cm作直切口,骨窗直径2.5～3.0 cm,暴露横窦与乙状窦交汇处。对小于3 cm的肿瘤先磨开内听道,切除内听道内肿瘤并分离出内听道端面神经及前庭蜗神经后,逐步切除颅内肿瘤;对超过3 cm的肿瘤先分块切除颅内肿瘤,找到脑桥端面神经后再逐步将面神经从肿瘤上分离,最后磨开内听道,切除其内肿瘤。术毕骨瓣复位固定。结果本组听神经瘤全切48例,次全切14例;46例面神经解剖保留,10例听力保留;脑脊液漏2例,无死亡病例。术中无一例输血,无皮下积液。结论枕下乙状窦后小骨窗入路可提供足够的手术空间进行听神经瘤切除,明显减少了医源性损伤,具备微创性、安全性和有效性。

Objective To summarize the surgical experiences in acoustic neuroma resection via the suboccipito - retrosigmoid keyhole approach. Methods Sixty - two patients with acoustic neuroma received surgical tumor resection via the suboeeipito - retrosigmoid keyhole approach. During the operation, a small vertical incision was made 1.5 em medial to the posterior margin of the sigmoid sinus and a bone window of 2. 5 - 3.0 cm in diameter was opened. For the tumors smaller than 3 cm in diameter, the internal auditory cenal was drilled open first. After removing the partial tumor and separating the facial never and cochlear nerve in the internal auditory canal, the intracranial part of the tumor was subsequently removed. For tumors larger than 3 cm in diameter, the intracranial part of the tumor was removed first. After exposing the facial nerve at the pons and carefully dissecting it from tumor, the internal auditory meatus was drilled open and the residue tumor was removed. The bone flap was replaced and fixed after the tumor resection. Results Total and subtotal tumor resection were achieved in 48 and 14 eases, respectively. Anatomical preservation of the facial nerve was a- chieved in 46 cases and so was hearing in 10 cases. Postoperative cerebrospinal fluid leakage occurred in 2 cases. No surgical death was reported. No patients received blood infusion during the surgery, nor subcutaneous effusion after the operation. Conclusion Acoustic neuroma can be safely and effectively reseeted via the suboccipito -retrosigmoid keyhole approach, which providesexcellent exposure of the tumor with minimal invasion.