听神经瘤治疗策略和手术效果的研究——附594例报告

Management Strategy and Surgical Outcomes in Acoustic Neuroma: A Report of 594 Cases

目的探讨听神经瘤手术效果及治疗策略选择。方法回顾性分析2001年1月至2010年12月共594例听神经瘤患者所采用治疗策略及其中461例手术效果。结果 594例患者中,管内/小型、中/中大型、大/巨型听神经瘤分别占25.6%、55.1%和19.3%,随访观察、立体定向放疗和手术率分别为25.3%、6.9%、77.6%。461例手术患者中,肿瘤全切、近全切、次全切率分别为95.9%、3.0%、1.1%,面神经解剖保留94.4%,术后短期和长期面神经功能良好率为69.8%和79.0%,术后听力保留率41.4%,听力良好率23.4%,手术死亡率0.2%,后组颅神经麻痹和脑脊液漏率分别为3.9%和3.3%,复发率为2.2%。结论手术仍为听神经瘤主要治疗策略,其效果令人满意,而听神经瘤早期诊断将促进治疗策略的改变。

Objective To report surgical outcomes and management strategies in acoustic neuroma. Methods Man？agement strategies and surgical outcomes in 594 patients with sporadic acoustic neuroma （461 surgical procedures） treated from January 2001 to December 2010 were retrospectively reviewed. Results The rate of intracanal/small, medium/moder？ately large and large/giant tumors was 25.6%, 55.1%and 19.3%respectively in the 594 cases. The rate of“wait and scan”, radiotherapy and surgery in this group was 25.3%, 6.9% and 77.6% respectively. Of the 461 surgeries, the rate of total, near-total and subtotal removal was 95.9%, 3.0%and 1.1%, respectively. The rate of intraoperative anatomical preserva？tion of the facial nerve （FN） was 94.4%. Short-term and long-term good FN function rates were 69.8%and 79.0%. The rate of hearing preservation and useful hearing were 41.4%and 23.4%. The mortality rate was 0.2%. The rates of lower cranial nerve palsy and cerebrospinal fluid leakage were 3.9%and 3.3%. Recurrence rate was 2.2%. Conclusions Surgical resec？tion is still the main management approach in acoustic neuroma, with satisfactory outcomes. The management strategy may be changed by early diagnosis of tumor.