显微手术切除大型、巨大型听神经瘤

Microsurgical treatment of large and extra large acoustic neurinomas

目的总结自１９８４年以来采用显微外科技术对大型、巨大型听神经瘤３８２例手术切除的体会，以提高此类肿瘤的手术治疗效果。方法采用显微外科技术，枕下乙状窦后小骨商经内听道入路，切除肿瘤，其中１３２例手术是在神经功能监护仪的监测下进行。结果肿瘤全切率为９５％，面神经保留率７３％；在神经功能监护仪的监测下，肿瘤全切率为１００％，面神经保留率为９８％，耳蜗神经保留率为４２％。自１９９０年以后无手术死亡。结论对于大型、巨大型听神经瘤，必须在手术显微镜下进行，磨除内听道后壁，切除内听道内的肿瘤，才能做到真正意义上的肿瘤全切。术中应用神经功能监护仪对面、耳蜗神经的辨认及保护尤为重要，并可估计术后面神经功能恢复的程度。

Objective This paper summarize our experience of 382 patients with large and extra large acoustic tumors underwent surgery in the department of nuerosurgery, 301 hospital since 1984. Method The most cases were operated on via the retrosigmoid approach through a small craniectomy by microsurgicla technique and 132 cases with intraoperative cranial nerve monitoring. Result A complete tumor removal was achieved in 95% and the facial nerve were preserved anatomically in 73% of all cases. Since intraoperative cramal nerve monitoring was used, a total tumor removal has been achieved in 100%, the facial nerve were preserved anatomically in 98% and cochlea nerves were preserved in 42%. There were no mortality since 1990. Conclusion It is necessary to use the nmicrosurgical technique for total removal of large or extra large acoustic tumor. Drill off the posterior internal auditory canal and remove the tumor inside the internal auditory canal were fundamental to reach the meaning of total remoual of the tumor, Intraoperative cranial nerve monitoring was very useful to identify and preserve the facial and cochlea nerves, and could predict the postoperative function of facial nerve.