大型听神经瘤的显微手术治疗

Microsurgical treatment of large acoustic neurinoma

目的 报道听神经瘤经枕下 乙状窦后显微手术切除的临床经验。提高大型听神经瘤的全切除率和面、听神经的保留率。 方法 回顾性分析临床 3 9例经显微神经外科手术治疗的大型听神经瘤 ,对影响肿瘤全切除的因素及手术中的关键技术点进行分析。 结果 肿瘤全切除 3 4例 (占87 2 % ) ,次全切 5例。术中解剖保留面神经 3 1例 (79 5 % ) ,听神经解剖保留 15例 (3 8 5 % ) ,其功能保留率分别为 5 6 4 %、17 95 %。 结论 应用显微外科技术是提高听神经瘤手术切除率和面、听神经解剖和功能保留率的关键。术中诱发电位的应用可提高面、听神经解剖和功能保留率。

Objective To discuss microsurgical experience for transsuboccipital retrosigmoid sinus approach of large acoustic neuronomas,and improve the rate of tumor removing,and facial nerve and auditory nerve preserving Methods A retrospective analysis of 39 patients with acoustic neuronomas which were more than 4 cm in diameter were treated by microsurgery between January 1994 and December 2000 Tumor's excision was performed by transsuboccipital retrosigmoid sinus approach The surgical main points of transsuboccipital retrosigmoid sinus approach,and their experience of total removal,and rate of facial nerve and auditory nerve preservation were described Results The tumors were totally removed microsurgically in 34 patients,the total removal rate was 87 2%,and subtotal removal in 5 patients Facial nerve was anatomically preserved in 31 cases,the rate of facial nerve preservation was 79 5%,but the function of facial nerve was recovered in 22 cases (56 4%) The auditory nerve was preserved anatomically in 15 cases (38 5%) and functionally in 7 cases (17 95%) Conclusions An minimally invasive microsurgical treatment are crucial for increasing a satisfactory living quality of the patients It is considered that the total removal rate of tumor,the preservative rate of facial nerve and auditory depend upon microsurgical technique and intraoperative facial nerve monitoring in acoustic neuromas surgery