听神经瘤显微外科手术治疗

Microsurgical treatmeat of acoustic schwannoma

目的报告 ２２３例中型、大型听神经瘤显微外科手术治疗效果。方法应用枕下开颅乙状窦后经内听道入路显微外科手术切除肿瘤。结果肿瘤全切除２０８例（９３％），近全切除６例（３％），次全切除９例（４％）。面神经解剖保留２０１例（９０％），面神经功能Ｈ－ＢⅠ、Ⅱ级１１８例（５３％）；Ⅲ、Ⅳ级９１例（４１％）；Ⅴ、Ⅵ级１４例（６％）。耳蜗神经功能保留率９％。术后长期随访结果显示９８％的病人恢复良好，１例生活不能自理，２例（１％）死亡。结论显微外科手术是治疗大、中型听神经瘤的有效方法，熟悉肿瘤与面神经的病理解剖关系有助于提高手术效果。

Objective 223 cases with middle and large size acoustic schwannomas were reported in this article to study the method of microsurgical treatment and improve the surgical effect. Method All of the cases were treated by suboccipital retrosigmoid-ICA approach from March 1996 to June 2000. Result Tumors were completed resected in 208 cases(93.5%), nearly completely resected in 6 cases (2.8%), subtotally resected in 9 cases (4.8%). Anatomic preservation of the facial nerves were achieved in 201 cases (90.4%). Patients' House-Brackmann Score after operations were as follows: 118 cases (53%)with H-B GradeⅠ.Ⅱ; 91 cases(41%)with H-B GradeⅢ.Ⅳ; 14 cases(5.9%) with H-B GradeⅤ.Ⅵ. The rate of hearing preservation was about 8.9%. Conclusion Microsurgical treatment is an effective measure for acoustic schwannoma. preceive technique, pathological anatomy and preservation method of facial nerve can improve surgical result.