经迷路径路听神经瘤手术中对颈静脉球的处理

Management of the jugular bulb during acoustic neuroma surgery via translabyrinthine approach

目的探讨经迷路径路听神经瘤手术中处理颈静脉球的方法和临床疗效。方法回顾性分析上海交通大学医学院附属第九人民医院耳鼻咽喉科2016年1月～2017年6月由同一术者经迷路径路手术治疗的72例听神经瘤患者的临床资料,包括术中对颈静脉球的处理和效果。结果 72例患者中颈静脉球高位的出现率为29.2%(21例)。术中所有颈静脉球均予清楚暴露。为充分显露桥小脑角,降低50例颈静脉球的高度,其中颈静脉球破裂4例,均为高位颈静脉球(3例使用双极电凝止血,1例通过止血纱布和骨蜡填塞止血)。肿瘤直径为(2.4±1.5)cm,手术全切70例,次全切除2例。术后面神经解剖及功能保留72例,均未出现后组脑神经功能异常。术后一年随访复查MRI未见肿瘤复发,面神经功能HB-I～II 66例(91.7%),HB-III～IV 6例(8.3%)。结论经迷路径路手术中恰当处理颈静脉球,可充分显露桥小脑角,同时降低颈静脉球破裂和误伤后组脑神经的风险。

Objective To investigate the management methods and outcomes of the jugular bulb(JB)during acoustic neuroma(AN)surgery via translabyrinthine approach.Methods Clinical data,including management methods and results of the JB,of 72 patients with AN surgically treated via translabyrinthine approach by the same surgeon between Jan.2016 and June 2017 in our department were analyzed retrospectively.Results Of all 72 cases,the incidence of high jugular bulb(HJB)was 29.2%(21 cases).The exposure of JB was satisfactory in all the cases.During lowering the JB to expose the inferior compartment of cerebellopontine angle(CPA)in 50 cases,intraoperative rupture of the JB occurred in 4 cases with HJB.For hemostasis,Surgicels~?was packed in the ruptured JB in 3 patients,and one was treated with bipolar coagulation.The maximal diameter of the AN was(2.4±1.5)cm.Total resection of AN was achieved in 70 patients,and subtotal resection in 2.Facial nerve was preserved both anatomically and functionally with normal function of the posterior cranial nerves in all the 72 cases.One-year follow-up revealed no tumor recurrence in magnetic resonance imaging(MRI)examination in all cases,and facial nerve function of House-Brackmann(HB)grade I or II in 66 cases(91.7%)as well as HB grade III or IV in 6(8.3%).Conclusion Proper management of JB during AN surgery via translabyrinthine approach provides adequate exposure of CPA with simultaneous reduction of risks of JB rupture and posterior cranial nerves injury.