改良扩大迷路径路在听神经瘤手术中的应用

Application of modified enlarged translabyrinthine approach in the removal of vestibular schwannoma

目的 探讨听神经瘤扩大迷路径路联合中耳切除及外耳道封闭技术,即改良扩大迷路径路的手术效果.方法 收集2001年1月至2012年12月共28例采用改良扩大迷路径路手术的听神经瘤患者临床资料,肿瘤直径25 ～ 52 mm,平均直径为（38.2±9.1） mm.分析其术中肿瘤全切率、术后脑脊液漏发生率、术后并发症、术中面神经保留及术后面神经功能.结果 28例行改良扩大迷路径路患者的肿瘤全切率为100％,术后无患者死亡.1例患者（3.5％）术后发生脑脊液漏.术中面神经解剖保留率为89.3％（25/28）；术后近期和远期面神经功能良好率分别为25.0％ （7/28）和42.9％ （12/28）.结论 对于肿瘤直径＞3 cm且向桥小脑角前方生长、肿瘤侵犯面神经迷路段、高位颈静脉球、乙状窦前置及颞骨过度气化的听神经瘤患者,经改良扩大迷路径路可获得良好的手术视野,并能够有效预防术后脑脊液漏的发生.

Objective To describe and analyze the surgical outcomes of modified enlarged translabyrinthine approach （ETLA）,which is combined with middle ear eradication and blind sac technique.Methods A retrospective study was conducted on 28 patients who underwent surgery for vestibular schwannoma （VS） via modified ETLA from Jan.2001 to Dec.2012.The sizes of tumors were 25-52 mn[（38.2±9.1）mm （x± s）].Main outcomes measures included the rate of total removal,the rate of cerebral spinal fluid （CSF） leakage after surgery,complications,and intraoperative anatomical preservation of facial nerve and facial nerve function.Results Among the 28 patients who underwent modified ETLA,the rate of total removal was 100%.There was no death after surgery via modified ETLA.The rate of CSF leakage after surgery was 3.5% （1/28）.The rate of intraoperative anatomical preservation of facial nerve was 89.3% （25/28）.Short-term and long-term good facial nerve function rates were 25.0% （7/28） and 42.9% （12/28）,respectively.Conclusions Modified ETLA is suitable for VS 〉 3 cm with extension to the anterior region of cerebellopontine angle,VS involve with labyrinth part of facial nerve,high jugular bulb,preposing sigmoid sinus and highly pneumatized temporal bone.This approach can provide a wide surgical field and well prevention of CSF leakage.