听神经瘤显微手术与面神经保护

Intraoperative facial nerve reservation in patients with acoustic neuromas

目的探讨大中型听神经瘤的显微手术治疗及面神经保护技巧。方法自2007年9月至2011年9月在面神经电生理监测下采用枕下乙状窦后入路显微手术切除大中型听神经瘤142例。结果肿瘤全切除136例(95.7%),次全切除6例(4.3%)。术中面神经解剖保留132例(93.0%),面神经与肿瘤粘连紧密无法保留10例(7.0%)。本组无长期昏迷及死亡病例。术后出现颅内感染3例、后组颅神经受损7例、眼睑闭合不能90例,无脑脊液漏病例。所有病人术后均随访3个月到2年,无术后复发病例;按House-Brackmann分级评估面神经功能,Ⅰ～Ⅱ级78例(54.9%),Ⅲ～Ⅳ级53例(37.3%),Ⅴ～Ⅵ级11例(7.8%)。结论充分了解桥脑小脑角区显微解剖知识,特别是了解听神经瘤与面神经的解剖关系,有助于提高手术效果。娴熟的操作技巧是手术成功的关键,术中监测及面神经的保留有助于面神经功能的保护。

Objective To summarize the experience in intraoperatively reservating facial nerves in patients with acoustic neuromas. Methods The clinical data of 142 patients with acoustic neuromas, who were treated in our hospital from September, 2007 to September, 2011, were analyzed retrospectively. All the patients were treated by microsurgery through suboccipital retrosigmoid approach under neurophysiological monitoring of the facial nerves. Results The total resection of the tumors was achieved in 136 （95.7%） patients and subtotal in 6 （4.3%）. The facial nerves were anatomically reservated in 132 （93.0%）. All the patients were followed up from 3 months to 2 years and the outcomes showed that the facial nerves funetion of 78 （54.9%）, 53 （37.3%） and 11 （7.8%） patients belonged in House-Brackmann grades Ⅰ -Ⅱ, Ⅲ]-Ⅳ and Ⅴ- Ⅵrespeetively. Conclusions Fully understood the anatomy of cerebellopontin angle, especially the positional relationship between the acoustic neuroma and facial nerve, and skilled microsurgical techniques are helpful to the inerease in the rate of total resection of the aeoustic neuromas and the reservation rate of faeial nerve. The intraoperative neurophysiological monitoring is a good method to increase the reservation rate of facial nerve in the patients with aconstie neuromas.