改良经耳囊径路在听神经瘤手术中的初步应用

Preliminary application of modified transotic approach in acoustic neuroma surgery

目的探讨改良经耳囊径路在听神经瘤手术中的初步应用。方法回顾性纳入2017年3月至2017年8月首都医科大学附属北京天坛医院耳鼻喉科采用改良经耳囊径路行手术切除的8例听神经瘤患者，术后6h复查头颅CT排除颅内出血；术后1周复查头颅MRI判定有无肿瘤残留。所有患者均行门诊随访，随访内容为按House—Brackmann（H—B）分级标准评估面神经功能。结果8例患者均完全切除肿瘤，面神经结构均保留。术后6h复查头颅CT，8例患者均无颅内出血；术后1周复查头颅MRI，8例患者均未见肿瘤残留。术后8例患者的患耳均丧失听力，其中5例出现眩晕，经对症治疗后症状缓解。所有患者术后均无脑脊液耳漏、颅内出血，颅内感染、偏瘫等并发症，无一例死亡。8例患者的随访时间为2周至5个月，平均（10．3±7．2）周。按照H—B分级标准评估面神经功能，其中3／8的患者为I级，3／8的患者为Ⅱ级，1／8的患者为Ⅲ级，1／8的患者为Ⅳ级。结论改良经耳囊径路可在保留耳蜗结构的基础上实现对听神经瘤的完全切除，同时可以最大限度地保留面神经功能，并减少脑脊液漏等术后并发症。

Objective To investigate the preliminary effect of refined transotic approach in acoustic neuroma surgery. Methods The clinical data of 8 patients with acoustic neuromas were enrolled into this retrospective study who underwent operation via modified transotic approach at Department of Otorhinolaryngology, Beijing Tiantan Hospital, Capital Medical University from March 2017 to August 2017. Intracranial hemorrhage was excluded by cranial CT at 6 hours post operation, and MRI was performed for observation of the residual tumor 1 week post operation. The facial nerve function was evaluated according to the House-Brackmann （H-B） classification system in all patients who were followed up at the outpatient clinic. Results All 8 patients had complete resection of the tumor. The facial nerve structure was preserved. According to the results of CT and MRI examinations, there was no intracranial hemorrhage or residual tumor in the patients. After surgery, all patients were single-sided deaf. Five patients experienced vertigo, which was relieved after treatment. There was no cerebrospinal fluid leakage or other severe complications such as intracranial infection, hemiplegia and death. All patients were followed up for 2 weeks to 5 months with an average of 10.3±7.2 weeks. Postoperative facial nerve function was assessed by the H- B classification system, which suggested that 3 patients were grade Ⅰ, 3 patients were grade Ⅱ, 1 patient was grade Ⅲ, and 1 patient was grade IV. Conclusions Refined transotic approach could facilitate the radical removal of tumor on the basis of intact cochlear structures and help with preservation of facial nerve and reduction of surgical complications such as cerebrospinal fluid leakage.