经枕下乙状窦后锁孔入路切除大型前庭神经鞘瘤

Large Vestibular Neuroma Resection through Suboccipito-retrosigmoid Keyhole Approach: Experiences of 37 Cases

目的探讨经枕下乙状窦后锁孔入路切除大型前庭神经鞘瘤的治疗策略和显微外科手术。方法回顾性分析2010年1月至2012年9月采用经枕下乙状窦后锁孔入路手术治疗的大型前庭神经鞘瘤37例患者的临床、影像学、手术过程及随访资料。结果37例神经鞘瘤均经病理证实，无死亡及发生严重并发症的病例。肿瘤次全切除1例，大部切除1例，全切35例。全切率94．6％。37例患者面神经均获得解剖保留，解剖保留率100％。术后3～6个月随访，HB分级：I级9例，Ⅱ～Ⅲ级26例，Ⅳ级2例。术后3例患者有不同程度的听力保留，3个月后随访电测听听力在60～70dB，基本恢复至术前水平。结论经枕下乙状窦后锁孔入路能有效的提供桥小脑角的显露空间，可提高大型前庭神经鞘瘤的全切率和面神经功能的保留级别。

Aim To investigate the surgical strategies and microsurgical techniques for large vestibular neuroma. Methods A retrospective analysis of the clinical, radiographic, operative, and follow-up data was performed in 37 patients with large vestibular neuroma who underwent surgical resection in our department from January 2010 to September 2012. Results Gross total resection was performed in 35 （94.6%） of the 37 patients, near total resection in 1 （2.7%）, and subtotal resection in 1 （2.7%）. The facial nerve was anatomically intact at the end of surgery in 37 （100%） patients. In 3-6 months after surgery, 35 （94.6%） patients had good facial nerve function （House Brackmann （HB） Grades I -Ⅲ）, 2 （5.4%） patients had regular facial nerve function （HB Grades IV）. The mortality rate was zero. Conclusion The suboccipito- retrosigmoid keyhole approach is a valid choice for removal of large vestibular neuroma. Through this approach, cerebellopontine angle （CPA） can be effectively exposed. Skills of protecting facial nerve and practiced microsurgical techniques can significantly improve the rates of large vestibular neuroma totally resected and grades of facial nerve protected.