囊性听神经瘤的显微手术策略与临床分析

Microsurgical treatment and clinical features of cystic acoustic neuroma

目的探讨囊性听神经瘤的临床特点及其显微外科手术的治疗方法。方法回顾性分析2013年1月～2017年12月华中科技大学同济医学院附属同济医院神经外科收治的囊性听神经瘤69例。所有囊性听神经瘤均行手术治疗,采用枕下乙状窦后入路。结果肿瘤全切61例(88.4%),次全切除6例(8.7%),部分切除2例(2.9%);面神经解剖保留率为64例(92.7%)。术后2周采用面神经功能House-Brackmann分级,其中Ⅰ-Ⅱ级47例(68.1%),Ⅲ-Ⅳ级16例(23.2%),Ⅴ-Ⅵ级6例(8.7%);术后后组脑神经功能障碍4例(5.8%),术后实用听力保留患者4例(5.8%)。结论囊性听神经瘤应尽量早期积极手术,在充分保护面神经功能的前提下,力争全切肿瘤。同时术者丰富的显微外科技术,以及超声刀、激光刀、电生理监测等重要工具的应用,是保障囊性听神经瘤手术效果和保全神经功能的关键因素。

Objective To investigate the microsurgical treatment and clinical features of cystic acoustic neuroma.Methods Clinical data of 69 patients with cystic acoustic neuromas treated by microsurgical procedures in our department from Jan. 2013 to Dec. 2017 were analyzed retrospectively. Suboccipital retrosigmoid approach was adopted in all patients.Results Total tumor resection was achieved in 61 cases(88.4%, 61/69), subtotal resection in 6(8.7%, 6/69) and partial resection in 2(2.9%, 2/69). Facial nerve was preserved anatomically in 64 cases with a preservation rate of 92.7%. Two weeks after operation, all patients received evaluation of facial nerve function according to the House-Brackmann(HB) grading system. Of them, 47 cases(68.1%) were HB gradeⅠ-Ⅱ, 16 cases(23.2%) were Ⅲ-Ⅳand 6 cases(8.7%) were Ⅴ-Ⅵ. Postoperative dysfunction of cranial nerves Ⅸ to Ⅻ occurred in 4 cases(5.8%). Moreover, practical hearing was preserved in 4 cases(5.8%).Conclusion The treatment of cystic acoustic neuroma should aim at early total surgical resection of tumors and preservation of neurological function. In addition, competent microsurgical skills, appropriate surgical approach, as well as modern surgical instruments are crucial for curative effect of operation and preservation of nerve function.