经扩大迷路进路巨大听神经瘤摘除术(英文)

Removal of large acoustic neuromas by enlarged translabyrinthine approach

目的 :探讨通过扩大的迷路进路切除巨大听神经瘤的手术方法和手术效果。 方法 :扩大迷路进路的要点是 ,充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜 ,暴露并下压颈静脉球 ,内听道周围骨质 2 70°以上切除。肿瘤切除应从前下极处开始 ,以早期暴露脑干及脑干表面面神经 ,随后即可从内侧向外侧解剖面神经。术中均使用面神经监护仪 ,术后均复查CT和 MRI。结果 :18例直径在 3cm以上的听神经瘤 (平均直径 4.2 cm) ,均能手术全切 ,脑组织无明显损伤 ,2例术后一过性脑脊液漏自愈 ,无颅内感染 ;面神经解剖及功能保存 14例 ,其中 8例面神经功能 1～ 2级 (4 4% ) ,6例面神经功能 3～ 4级(33% ) ,4例面神经中断者均为术前已有重度面瘫或已中断 ;16例术后 1～ 3月恢复工作 ,2例恢复生活自理。结论 :经扩大迷路进路既能达到全切巨大听神经瘤的目的 ,同时具有损伤小。

Objective: To investigate the surgical methods and outcomes of the enlarged translabyrinthine approach in the removal of large acoustic neuromas. Methods: A large mastoidectomy involved complete exposure of the sigmoid sinus, the dura behind the sinus for at least 1 cm, the superior petrosal sinus and the middle fossa dura. The jugular bulb was exposed and pressed downwards if necessary. The internal auditory meatus was skeletonized and uncovered for at least 270°. The debulking of the tumor began inside the anterior and inferior poles in order to find the brainstem and the facial nerve root as early as possible, and then the dissection of the nerve was done medially to laterally. Intraoperative facial nerve monitoring and postoperative CT and MRI were done in all cases. Results: Total removal was achieved in all 18 patients with tumors larger than 3 cm (mean size: 4.2 cm). There were no deaths or other complications such as intracranial infection and persistent cerebrospinal fluid leakage. There were no obvious cerebral sequelae. The facial nerve was preserved both anatomically and functionally in 14 cases, with Grade Ⅰ or Ⅱ in 8 cases, Grade Ⅲ or Ⅳ in 6 cases. Nerve interruption occurred in 4 patients who all had severe facial palsy or nerve interruption before operation. Sixteen patients resumed work within 1 3 months. Conclusion: Total removal of large acoustic neuroma could be acomplished via the translabyrinthine approach, with good preservation of facial nerve function and minimum incidence of morbidity. [