大型听神经瘤显微手术切除及面听神经保留技巧

Skill for microsurgical removal and preservation of facial nerve and hearing for large acoustic neuromas

目的介绍大型听神经瘤显微手术切除及面听神经保留技巧。方法对５１例大型听神经瘤采用乙状窦后入路显微手术切除。结果所有５１例病人均行肿瘤全切，面神经解剖保留率为９６％。根据Ｈｏｕｓｅ－Ｂｒａｃｋｍａｎｎ面神经功能分级标准，２０例（３９％）术后３个月内面神经功能为Ⅰ～Ⅱ级， ２７例（５３％）为Ⅲ～Ⅳ级，４例（８％）Ⅴ－Ⅵ级。根据 Ｇａｒｄｅｎｅｒ－Ｒｏｂｅｒｔｓｏｎ听力分级标准，３例（６％）听力保留。无手术死亡、脑干和后组颅神经损害及其他严重并发症。结论采用显微手术技术，绝大多数大型听神经瘤均可以在保留面神经解剖完整的前提下手术全切。

Objective To introduce the skill for microsurgical removal and preservation of facial nerve and hearing for acoustic neuromas. Method 51 acoustic neuromas were microsurgically removed by retrosigmoid approach. Result All of the tumors were totally resected. 49 of 51(96%) facial nerves were anatomically preserved. According to House-Brackmann facial nerve grading system, 20 of them (39) were grade Ⅰ or Ⅱ,27 were Ⅲ or Ⅳ, and 4 were Ⅴ or Ⅵ in 3 months. 3 of 51 were hearing preserved on Gardener-Robertson system for grading hearing preservation. No post-operative death, brainstem and Ⅸ,Ⅹ,Ⅺ dysfuntion or other serious complications. Conclusion Almost all of the large acoustic neuromas could be totally resected with an anatomically intact facial nerve.