听神经瘤枕下乙状窦后锁孔入路的临床探讨

Clinical study of keyhole craniotomy through suboccipital retrosigmoid sinus approach for acoustic neurinomas

目的 探讨改良听神经瘤枕下乙状窦后入路的手术方法 ,预防并发症 ,减少手术损伤。方法 对 11例听神经瘤采用单侧枕下乳突后小“丿”形皮肤切口 ,枕下乙状窦后“锁孔”入路显微手术切除肿瘤 ,后颅窝开颅术改咬骨窗为开骨瓣术。结果 10例肿瘤全切除 ,1例近全切除 ;面神经解剖保留 9例 ,术后 2～ 9个月复查面神经House Brackmann(H -B)Ⅰ～Ⅱ级 7例、Ⅲ～Ⅳ级 3例 ,Ⅴ级 1例。术后未见明显并发症。结论 改良枕下乙状窦后“锁孔”入路是一种有效、安全、便捷的微创手术入路。它的优点是解剖复位、创伤小、并发症少 。

Objective To study suboccipital retrosigmoid sinus approach in acoustic tumor resection, and discuss how to improve the surgical skills and effects. Methods Eleven acoustic neurinomas were operated with keyhole craniotomy through unilateral modified suboccipital retrosigmoid approach with “丿” incision from September 2000 to August 2001. We used suboccipital craniotomy in the removal of the acoustic neurinomas in order to maintain anatomical replacement. All patients underwent the craniotomy and the tumors were removed under the microscope. Results Tumors were completely resected in 10 cases, and nearly totally removed in one case. Nine patients had obtained anatomic preservation of the facial nerves. Patients' House-Brackmann Score 2-9 months after operation were 7 cases with H-B Grade Ⅰ～Ⅱ, 3 cases with H-B Ⅲ～Ⅳ and 1 case with H-BⅤ. Conclusion Microsurgery with keyhole craniotomy is a safe and effective method in the treatment of acoustic neurinoma. The advantages of keyhole suboccipital craniotomy are anatomical replacement, less postoperative complications caused by suboccipital craniotomy, and beneficial to patients' mental health. Improving incision suboccipital retrosigmoid sinus approach is an approach for acoustic neurinomas insection with small invasion.