大型听神经瘤显微外科治疗

Microsurgical treatment of large acoustic neuroma

目的：探讨显微手术治疗大型听神经瘤及保护面听神经的手术技巧。方法：回顾性分析经枕下乙状窦后入路显微手术切除的37例大型听神经瘤的临床资料。结果：37例患者中,肿瘤全切及近全切除32例（占86.4%）、次全切5例（占13.6%）;术中解剖保留面神经33例（89.1%）,耳蜗神经解剖保留11例（29.7%）,肿瘤切除后1年复查。面神经功能Ⅰ～Ⅱ级30例（81.1%）,Ⅲ～Ⅳ级4例（10.8%）,Ⅵ～Ⅴ级3例（8.1%）,耳蜗神经功能保留8例（21.6%）。结论：熟练掌握桥小脑角区的局部解剖、手术入路及显微操作技巧并辅助使用内镜及术中监测,是提高大型听神经瘤全切率和面听神经保留率的有效方法。

Objective：To investigate the technology strategy of the microsurgical treatment in large acoustic neuroma and auditory nerve pretection.Methods：Data of 37 cases of large acoustic neuroma which were microsurgical resected through the suboccipital sigmoid sinus approach were retrospectively analyzed.Results：Of the 37 cases,32 cases（86.4%）underwent tumor total resection or nearly total resection,5 patients（13.6%）subtotal resection;33 cases（89.1%）of facial nerves were anatomically preserved and 11 cases（29.7%）of cochlear nerve were anatomically retained during operations.All patients were reviewed 1 year after tumor resection,the facial nerve functions were classified and the function and functional outcome of facial nerve were evaluated.Of all the 37 cases,the functions of facial nerves in 30 cases（81.1%）were in grade Ⅰ ～ Ⅱ,4 cases（10.8%）in gradeⅢ～Ⅳ,3 cases（8.1%）in gradeⅥ～Ⅴ,and the functions of cochlear nerves in 8 cases（21.6%）were reserved.Conclusion：It is an effective strategy to improve the rate of total resection on large acoustic neuroma and facial nerve reservation for us to master the local anatomy of the cerebellopontine angle area,the surgical approach,the microscopic techniques,the use of endoscope and the intraoperative monitoring as well.