大型听神经瘤手术并发症及其预防

Complications of Surgery for Large Acoustic Neuromas and Their Prevention

目的探讨枕下入路切除大型听神经瘤的常见手术并发症及相关因素,总结其预防方法。方法收集本科220例大型听神经瘤的临床资料及术后随访结果进行回顾性研究。结果220例大型听神经瘤全切199例(90.5%),次全切21例(9.5%),面神经解剖保留129例(58.6%),蜗神经解剖保留10例(4.5%),主要并发症包括:脑脊液漏(2.3%)、脑膜炎(8.6%)、后组颅神经麻痹(7.7%),术后血肿形成(2.7%)等。手术死亡7例(3.18%)。结论熟悉手术入路相关临床解剖、积累手术经验、术前对患者影像学及临床资料进行个体化研究是减少手术并发症的关键。

Objective To explore the common complications related to the suboccipital approach for resection of large acoustic neuromas and methods of preventing them.Method The clinical data of220patients large acoustic neuromas,who underwent surgeries through the suboccipital approach in our hospital from1992to2000,were reviewed retrospectively.Result Of220patients with large acoustic neuromas,199(90.5%)received total resection of the tumors and21partial.Anatomic preservation of the facial nerve was achieved in129cases(58.6%)and of the cochlear nerve in10cases(4.5%).Major complications included cerebrospinal fluid fistulas(2.3%),meningitis(8.6%),caudal cranial nerve palsies(7.7%),and hematomas(2.7%).Eleven patients died(3.18%).Conclusion The key to avoiding the complications is mastering the clinical anatomy of the approach,accumulating surgical experience and preoperatively studying the individual imaging and clinical data.