大型听神经瘤的外科治疗

Surgical therapy of large vestibular schwanomas(acoustic neuromas).

目的 报告 97例大型听神经瘤 (最大直径 >3cm)外科治疗的经验。方法 采取侧卧位 ,一侧枕下乙状窦后入路 ,探讨了肿瘤全切除、面神经及耳蜗神经保留的手术技巧 ,强调术中充分降低颅内压、良好暴露、显微镜下仔细操作、磨除内听道后壁以及术中使用面神经电刺激器、超声刀等设备。结果 肿瘤全切除率达 85 .6 % ,面神经解剖保留率 79.4% ,耳蜗神经解剖保留率 2 3.7% ,手术死亡率 2 .1% ,其死因 1例为脑干损伤 ,另 1例为颅内严重感染。结论 目前手术切除仍然是主要治疗手段。手术目标是尽可能全切肿瘤 ,并保留面神经和耳蜗神经。对于颅内高压严重者术前宜先行侧脑室钻孔外引流 。

Objective To report the surgical experiences in treating 97 cases of large vestibular schwannomas.Methods The patients were placed in the lateral prone position,and the suboccipital approach was adopted.The operating techniques of the complete tumor removal,the facial nerve preservation and the cochlear nerve preservation were explored.During the operations,the use of operating microscope and ultrasonic surgical aspirator and cranial nerve monitoring were emphasized.Results Complete tumor removal was achieved in 85.6% of the patients.Anatomic preservation of the facial nerve was achieved in 79.4% and of the cochlear nerve in 23.7%.The operative mortality was 2.1%(1 patient died of brainstem injury,and the other died of serious intracranial infection.[WT5”HZ]Conclusion Surgery is currently still the essential treatment for acoustic neuomas.The operation should be aimed at complete tumor removal and preservation of the facial and cochlear nerves.It is suggested that ventriculostomy and cerebral spinal fluid drainage be perfomed for those patients with severe intracranial hypertension and that attention be paid to the prevention and cure of surgical complications.