听神经瘤术中面神经的保护及病理走行研究

Preservation of the Facial Nerve during Acoustic Neuronoma Excision and Investigation of the Anatomical Location and Shape of Facial Nerve

目的研究面神经与听神经瘤的各种病理关系和总结术中面神经保护技巧。方法回顾性分析2007年1月-2012年3月收治的初次显微手术切除的585例听神经瘤患者的临床资料,统计面神经与听神经瘤的各种病理关系和面神经的解剖和功能保留率。结果肿瘤全切除552例（94.4%）,次全切33例。术中解剖保留面神经558例（95.4%）,术后1年面神经功能House-BrackmannⅠ~Ⅳ级549例（93.8%）。面神经位于肿瘤腹上型279例,腹中型243例,腹下型33例,背侧型10例,上方型6例,下方型3例,包裹型11例。结论准确把握面神经与肿瘤关系的各分型、术中的电生理监测再结合术者娴熟的显微手术技巧能明显提高面神经的解剖保留率,为患者术后面神经功能恢复提供有力保障。

Objective To study the anatomicopathological relation between facial nerve（FN） and acoustic neuronoma（AN） and summarize the techniques of how to protect facial nerves in microsurgery. Methods A retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and MarcTh2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. Results The tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. At er one-year follow-up, 549 patients had House-BrackmannⅠ- Ⅳfunction. The location and shape of the FN along the tumor was identiffied as the follows： FN displaced along the ventral and superior surface of the tumor in 279 patients（47.7%）, the ventral and central in 243（41.5%）, the ventral and inferior in 33（5.6%）, the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. Conclusion Good understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.