囊性听神经瘤手术疗效分析

Management of Cystic Acoustic Neuroma

目的总结囊性听神经瘤(cystic acoustic neuroma,CAN)的临床特点和手术效果。方法回顾性分析2001年1月至2010年12月共36例CAN病例,与同时期79例大/巨型实性听神经瘤(solidacousticneuroma,SAN)比较临床特点和手术效果。结果 CAN手术全切、近全切、次全切率分别为77.8%、16.7%、5.6%,面神经解剖保留率为77.8%,术后长期面神经功能良好率25.0%。CAN较SAN具有病程更短、颅神经症状更重、治疗策略以手术为主、近全切除率高、面神经解剖保留率低、离断率高、术后面神经恢复效果较差的特点。结论 CAN较SAN更具侵袭性、破坏性。瘤体生长迅速,易产生并发症。手术切除仍为首选治疗方法,但手术效果不甚理想,对周围型CAN(Ⅱ型),建议采用近全切除、次全切除以保留面神经、血管,减少并发症。

Objective To report clinical features and surgical outcomes of cystic acoustic neuroma （CAN）. Meth？ods A retrospective clinical analysis was conducted on 36 patients with CAN managed from January 2001 to December 2010. The clinical features and surgical outcomes were compared between these 36 cases of CAN and 79 cases of large or giant solid acoustic neuroma （SANs）. Results In the 36 cases of CAN, the total, near-total and subtotal resection rates were 77.8%, 16.7%and 5.6%, respectively. The rate of intraoperative anatomical facial nerve （FN） preservation was 77.8%. The rate of long-term good FN function was 25.0%. A comparison between CAN and SAN cases showed several special clinical features with the former：shorter duration of symptoms, more severe clinical symptoms, higher near-total removal rate, lower anatomical FN preservation rate, higher rate of FN disruption, and poorer recovery of FN function. Conclusions CAN is considered being more aggressive than SAN with more rapid growth and worse symptoms. Surgical resection is the first choice management for CAN, but surgical outcomes may not be unsatisfactory. We recommend near total or subtotal resec？tion in the case of peripheral thin-walled cystic tumors to protect the FN and reduce complications.