枕下乙状窦后入路显微切除术治疗97例听神经瘤的临床观察

Clinical observation on microsurgical resection of 97 cases of acoustic neurinoma through suboccipital retrosigmoid approach

目的了解枕下乙状窦后入路显微切除术治疗听神经瘤的疗效,为该疾病的治疗提供有效治疗方法。方法采用枕下乙状窦后入路显微切除术治疗97例听神经瘤患者。观察患者的手术效果和术后并发症情况。术后进行随访,根据House-Brackmann面神经分级标准对疗效进行评价。结果 97例患者全切除肿瘤83例,占85.57%;次全切除14例,占14.43%。未出现死亡病例;面神经功能保留56例,占57.73%;面神经解剖保留79例,占81.44%;有效听力保留4例,占4.12%。术后平均随访时间(8.1±2.4)个月,面神经分级结果为:Ⅰ级22例,占22.68%;Ⅱ级27例,占27.84%;Ⅲ级19例,占19.59%;Ⅳ级15例,占15.46%;Ⅴ级9例,占9.28%;Ⅵ级5例,占5.15%。结论采用枕下乙状窦后入路显微切除术可有效治疗听神经瘤,手术并发症较少,具有一定的临床推广价值。

【Objective】To find out the efficacy of microsurgical resection of acoustic neurinoma through suboccipital retrosigmoid approach; to find an effective surgical treatment method for the disease. 【Methods】97 cases with nacoustic neurinoma were treated with microsurgical resection through suboccipital retrosigmoid approach. Surgical results and postoperative complications of patients were observed. By postoperative follow-up, the efficacy was evaluated according to the House-Brackmann facial nerve grading criteria.【Results】Subtotal tumor operated in 83 cases, accounting for 85.57%; subtotal resection in 14 cases, accounting for 14.43%. Death case did not appear; facial nerve function preserved in 56 cases, accounting for 57.73%; facial nerve preserved in 79 cases, accounting for 81.44%; effective hearing preserved in 4 cases, accounting for 4.12%. The average postoperative follow-up time was（8.1±2.4） months, and facial nerve grading results：Ⅰ level in 22 cases, accounting for 22.68%; Ⅱ grade in 27 cases, accounting for 27.84%; Ⅲ grade in 19 cases, accounting for 19.59%; Ⅳ grade in 15 cases, accounting for 15.46%; Ⅴ grade in 9 cases, accounting for 9.28%; Ⅵ grade in 5 cases, accounting for 5.15%. 【Conclusions】In the treatment of nacoustic neurinoma, microsurgical resection through suboccipital retrosigmoid approach has exact effect, less surgical complications and clinical practice value.