锁孔微创手术切除听神经瘤65例临床分析

Clinical analysis of microsurgical resection of acoustic neurinoma via keyhole approach in 65 patients

目的探讨锁孔手术治疗听神经瘤策略,评价其在听神经瘤术中的可行性及神经电生理监测对面神经保护的意义。方法回顾性分析65例听神经瘤病人的临床资料,术前MRI增强扫描检查,术中锁孔乙状窦后幕下入路切除肿瘤,并应用神经电生理仪监测以保留面神经。结果术后复查MRI：全切除41例,次全切除17例,大部切除7例。面神经解剖保留49例,未能保留或未暴露16例。随访6个月~4年,面瘫情况（面神经功能House-Brackmann分级）,术后3 d：Ⅰ~Ⅱ级21例,Ⅲ~Ⅳ级34例,Ⅴ~Ⅵ级10例;术后6个月：Ⅰ~Ⅱ级47例,Ⅲ~Ⅳ级11例,Ⅴ~Ⅵ级7例。本组无小脑挫伤、病死、病残,无后组脑神经损伤及脑脊液漏发生。结论锁孔手术治疗听神经瘤疗效确切,安全性高。神经电生理监测有利于面神经判断及保留。

Objective To investigate the treatment strategies of acoustic neurinoma via keyhole approach and evaluate the feasibility and the significance of intraoperative neurophysiological monitoring in protecting the facial nerve. Methods Clinical data of 65 patients with acoustic neurinoma were analyzed retrospectively. The enhanced MRI was performed on all the patients before surgery. The tumors were removed via keyhole retrosigmoid sinus subtentorial approach. Intraoperative neurophysiological monitoring was used to protect the facial nerve. Results The postoperative MRI showed that total removal was achieved in 41 patients, subtotal removal in 17 and partial removal in 7. The facial nerve was anatomically preserved in 49 patients and was not preserved or exposed in 16. The patients were followed up for 6 months to 4 years. House-Brackmann facial nerve grading outcomes were as follows： Ⅰ-Ⅱ grades in 21 patients,Ⅲ-Ⅳ grades in 34, Ⅴ-Ⅵ grades in 10 at the 3rd after the surgery and Ⅰ-Ⅱ grades in 47 patients, Ⅲ-Ⅳ grades in 11, Ⅴ-Ⅵ grades in 7at the 6th month after the surgery. No cerebellum contusion, dead, disability, injury of posterior-group cranial nerves or CSF leak occurred. Conclusions The keyhole retrosigmoid sinus subtentorial approach is effective and safe for acoustic neurinoma. Intraoperative neurophysiological monitoring is helpful for protecting the facial nerve.