中小型听神经瘤的显微手术治疗

Microsurgery for the treatment of small and medium.size acoustic neuromas

目的探讨乙状窦后经内听道入路显微手术切除中小型听神经瘤的方法和临床效果。方法回顾性分析中南大学湘雅医院神经外科2003年10月至2013年11月显微手术治疗最大径〈3cm的77例听神经瘤患者的手术效果、术后生活质量及术后神经功能保留情况。患者均采用乙状窦后经内听道入路显微手术切除肿瘤。术后平均随访36．7个月（9～131个月）。结果77例听神经瘤患者中，肿瘤全切除76例，次全切除1例。术中面神经、三叉神经、岩静脉均解剖保留，蜗神经解剖保留率为68％。无手术死亡病例，2例术后出现颅内感染，1例出现脑脊液漏，经对症治疗后痊愈。所有患者均能在术后1年内恢复正常工作，远期生活质量评估（KPS评分）优良率为100％。在随访期间，肿瘤复发1例，再次手术全切肿瘤，术后面神经功能仍为House—BrackmannI级。末次随访时面神经优良率为96％，有效听力保留率为29％。34例术前面部麻木、疼痛的患者术后症状缓解或消失。结论对于最大径〈3cm的听神经瘤患者，显微手术可以实现较高的肿瘤全切率和神经功能保留率，并能明显缓解三叉神经的临床症状，可作为首选的治疗方法。

Objective To investigate the method and clinical effect of mierosurgical resection of small and medium-size acoustic neuromas via retrosigmoid approach. Methods The surgical effect, postoperative quality of life and postoperative nerve function preservation in patients with acoustic neuromas with the maximum diameter of 〈 3 cm treated with microsurgery at the Department of Neurosurgery, Xiangya Hospital Central South University from October 2003 to November 2013 were analyzed retrospectively. The postoperative mean follow-up time was 36. 7 months （range, 9-131 months）. Results Seventy-six patients had total tumor removal, while one had subtotal removal. The intraoperative facial nerves, trigeminal nerves, petrosal veins were preserved anatomically, and anatomic preservation rate of the cochlear nerves was 68%. No patient died during the operation. Two patients had intracranial infection after procedure, 1 had cerebrospinal fluid leakage, and they were cured after symptomatic treatment. All patients returned to work within one year after procedure. The excellent rate of the long-term quality of life assessment （ KPS score） was 100%. During the follow-up period, one patient had tumor recurrence, and his tumor was totally resected again. The postoperative facial nerve function was still House-Brackman grade 1. The excellent rate of facial nerve was 96% at the last follow-up. The effective hearing preservation rate was 29%. The symptoms were relieved or disappeared after procedure in 34 patients with preoperative facial numbness and pain. Conclusion For the maximum diameter 〈 3 cm of acoustic neuroma, microsurgery can achieve higher total resection rate and neural function retention, and significantly relieve the clinical symptoms of trigeminal nerves. It can be used as a preferred treatment method.