显微手术治疗囊性听神经瘤的临床研究

Microsurgery for Acoustic Neurilemoma with Cystic Degeneration:a Clinic Analysis

目的:探讨显微外科开颅治疗囊性听神经鞘瘤的肿瘤全切情况及面、听神经的保留情况。方法:回顾性分析2006年8月至2013年9月我院收治的42例经枕下乙状窦后入路开颅囊性听神经鞘瘤手术患者的临床资料,同时对37例患者进行术后随访,并对结果进行统计学分析。结果:囊性听神经鞘瘤(42例)手术全切率simpson(Ⅰ-Ⅱ级)为64.28%(27例),次全切除率(simpsonⅢ级)为26.19%(11例),部分切除率为(simpsonⅣ级)为9.53%(4例),面神经解剖保留率为71.43%(30例),面神经功能保留率为14.29%(6例),听神经解剖保留率为7.1%,听神经功能保留3例,较实质性听神经瘤的手术效果差。结论:囊性听神经瘤的面、听神经解剖与功能保护尚有难度,需要进一步提高。

Objective： To explore the results of total resection and facial and acoustic nerves reservation of microsurgery for acoustic neurilemoma with cystic degeneration. Methods： From August 2006 to September 2013, the clinical data of 42 cases of acoustic neurilemoma with cystic degeneration treated by microsurgically via retrosigmoid approach were retrospectively reviewed. Results： The gross total resection（simpsonⅠ-Ⅱ） achieved in 68% of patients（29 cases） and near total resection（simpson Ⅲ） in 22%（9 cases）, and 10% of patients（4 cases） had subtotal resection（simpson Ⅳ）. Anatomic reservation of facial nerve achieved in 27 cases and functional reservation in 6 cases, while anatomic preservation and functional preservation of acoustic nerve were 3 cases respectively. The total tumor resection ratio and nerve reservation ratio of cystic tumors are apparently lower than solid ones. Conclusion： The Facial never and acoustic never anatomical and functioncal Preservation still had difficulty and were needed to be further improved.