听神经鞘瘤的显微手术策略

Microsurgery treatment methods of acoustic neurilemoma

目的总结听神经鞘瘤(AN)的显微手术治疗策略。方法回顾分析38例在神经电生理监测下进行显微外科切除的AN患者临床资料。结果 38例患者肿瘤切除程度:全切27例(79.45%),次全切除10例(15.07%),大部切除4例(5.48%),术后死亡2例(2.74%)。面神经解剖保留70例(95.89%),术后患者面神经功能能评定:I～Ⅱ级54例(73.9%),Ⅲ～Ⅳ级16例(21.9%),V～Ⅵ级1例(1.4%)。结论良好的显微手术技巧可以有助于切除AN,神经电生理监测有助于提高AN患者面神经术中面神经保留率。

Objective To summarize the microsurgery methods of the acoustic neurilemoma. Methods The clinic data of 38 a- coustic neurilemoma patients, who were treated by microsurgery under the nerve electrophysiologic monitor, were analyzed retrospectively. Re- sults Among 38 patients cases, 27（71%） cases were totally resected, 10（26%）subtotally, 1 （3%） in greater part, and 1 （ 3% ） were postopera- tively dead. The facial nerve was kept anatomic intact in 32 cases （84%）, and the postoperative facial nerve grading was ： grade Ⅰ to Ⅱ in 28 （73%）,grade Ⅲ to Ⅳ in 3 （8%）, and gradeⅤ to Ⅵ in 7 （19%）. Conclusion Nicer mierosurgery skill could be favorable to resect the a- coustic neurilemoma. The nerve electrophysiologic monitoring could be favorable in keeping the anatomic intact of the operating facial nerve of the patients.