内听道型听神经瘤的外科治疗

Surgical treatment of intracanalicular acoustic neuroma

目的探讨和总结内听道型听神经瘤的临床显微手术技巧,以期提高手术疗效。方法回顾性分析2007年8月~2015年8月期手术的34例内听道型听神经瘤患者临床资料,探讨手术操作技巧,并总结肿瘤切除程度、术后并发症及远期随访情况。结果 34例患者均采用枕下乙状窦后入路,肿瘤最大径小于10mm 11例,介于10~20mm之间23例;肿瘤全切34例。无一例死亡。术后3个月轻度周围性面瘫2例,听力较术前下降17例。术后随访2年以上,听力较术前下降13例。结论乙状窦后硬膜下入路是切除内听道型听神经瘤的良好办法,磨除内听道后壁及锐性分离是操作核心。

Objective To investigate and summarize the microsurgical technique of intracanalicular acoustic neuroma, and to improve the surgical effect. Methods The clinical data of 34 patients who underwent removal of intracanalicular acoustic neuroma from Aug 2007 to Aug 2015 were analyzed retrospectively. The analyzed data included surgical technique, the extent of tumor resection, postoperative complications and long-term follow-up results. Results A retrosigmoid approach was adopted in all the 34 cases. As for the size of tumor, the maximal diameter was less than 10 mm in 11 patients and between 10 to 20 mm in 23. The total tumor resection was achieved in all the cases with no deaths. Postoperative follow-up at 3 months reveled mild peripheral facial paralysis in 2 cases and hearing loss in 7. Follow-up for more than 2 years showed no peripheral facial paralysis and hearing loss in 3 cases. Conclusion Removal of posterior internal auditory canal wall and sharp dissection as the cores of surgical operation, the retrosigmoid approach is favorable for the removal of intracanalicular acoustic neuroma.