听神经瘤安全切除及术中面神经保护解剖学基础

Microanatomy of the relationship between acoustic neuroma and the arachnoid

目的探讨听神经瘤的安全切除、术中面神经保护技术及解剖学基础。方法 121例听神经瘤全部采用枕下乙状窦后入路,在显微外科基础上采用神经电生理监测技术,配合超声吸引(CUSA)和激光刀切除肿瘤,术后采用House-Brackmann(HB)分级方法对面神经功能进行评价。结果肿瘤全切除100%(121例)。面神经解剖保留93.4%(113例),蜗神经解剖保留90.1%(109例),无死亡病例。术后3个月回访121例,按House-Brackmann分级对面神经功能评估,I-II级71.9%(87例),III-IV级25.6%(31例),V-VI级3.3%(4例)。结论掌握听神经瘤与蛛网膜关系的解剖学基础是听神经瘤安全切除及面神经功能保护的关键。

Objoelive To review microsurgical techniques and facial nerve preservation issues in resection of acoustic neuroma. Methods Clinical data of 121 patients with acoustic neuroma who were surgically treated in our hospital from Jan 2009 to Oct 2012 were retrospectively analyzed. Acoustic neurinomas were removed by microsurgical technique through the suboccipital retrosigmoid approach accompanied by face nerve EMG monitoring. Results Total separation was achieved in 100% （121cases）. The facial nerve was preserved anatomically in 93.4% （113 cases） and the cochlear nerve in 90.1% （109 cases）. There was no surgery-related fatality. In a 3-month follow-up, according to House-Brackmann, the function of facial never was I-Ⅱ level in 71.9% （87 cases）, Ⅲ-IV in 25.6% （31cases）, V-VI in 3.3% （4 cases）. Conclusion Profound understanding of the relationship between the acoustic neuroma and the arachnoid can drastically reduce the incidence of acial nerve damage during resection of acoustic neuromas.