双侧听神经瘤手术及伽玛刀治疗

The treatment of bilaterial acoustic neuromas and nerve function preservation

目的 :探讨双侧听神经瘤的显微外科手术及伽玛刀治疗方法 ,如何保留神经功能和长期的肿瘤控制率。方法 :2 4例病人中 13例病人先行一侧显微神经外科肿瘤全切除或部分切除后 ,再行对侧及残余肿瘤的伽玛刀治疗。结果 :11例双侧伽玛刀治疗的病人 ,肿瘤控制有效率为 86 % ,全部病人均保留不同程度听力 ,听力保留率为86 3%。手术结合伽玛刀治疗病人 13例 ,所有肿瘤均得到有效控制 ,一侧或双侧听力保留率为 5 7 6 %。全部病人肿瘤控制有效率为 93 4% ,听力保留率为 70 8% ,面神经功能保留 (Grade分级 1 2级 )为 83 0 %。结论 :双侧听神经瘤患者处理 ,应根据肿瘤的大小、病人的听力情况、解除脑干压迫的必要性 ,行肿瘤全部切除或部分切除 ,或行伽玛刀治疗 。

Objective:To investigate how to manage bilaterial acoustic neuromas with microsurgery and Gamma-knife treatment and how to preserve nerve function and gain long-term tumor cotrol rate.Methods:In the past five years,24 cases of bilaterial acoustic neromas patients received Gamma-knife (Stereotactic radiosurgery)treatment,13 of them received one side tumor resection partially or totally and then Gamma-knife treatment to the residual tumor or the contralateral tumor.Result:11 cases received bilatrial Gamma-knife treatment,and tumor control rate was 86%,All patients preserved hearing at different level.And hearing preservation rate was 86.3%.All the 13 cases receiving both neurosurgery and Gamma-knife treatment got effective tumor control and preserved at least one-side hearing.Hearing presevation rate was 57.6%.Tumor control rate of all the 24 patinets was 93.4%.Hearing preservation rate was 70.8%.Facial function (Grade Ⅰ-Ⅱ)preservation rate was 84.7%.Conclusion:Management of bilaterial and unilaterial acoustic neuroma is different.Accoding to tumor size,hearing level and brainstem invasion to decide total partially tumor resection or Gamma-knife treatment.Work should be done to preserve hearing,at least one-side useable hearing.