The present report should summarize our experience using minimally invasive techniques in acoustic neurinoma surgery at the Neurosurgical Department, University of Vienna, Austria. Based on the experience of about 687...The present report should summarize our experience using minimally invasive techniques in acoustic neurinoma surgery at the Neurosurgical Department, University of Vienna, Austria. Based on the experience of about 687 cases in a 20 year time period our mostly used techniques will be presented. This is a minimal invasive individual adapted approach, specified intraoperative strategy and dissection techniques (e.g. water jet dissection, ultrasonic aspirator CUSA), the use of neuronavigational systems and the use of endoscope assisted surgery. With respect to the limited space of place precise citations to further textbooks of the authors handling with this topic will be given. Finally our results using these techniques are presented and further future perspectives in the treatment of these pathology (radiosurgery) will be discussed.展开更多
The present report summarizes our experience using endoscopes and neuronavigational tech-niques as an assistance in minimally invasive tool in acoustic neurinoma surgery.Based on the experience in about 100cases done ...The present report summarizes our experience using endoscopes and neuronavigational tech-niques as an assistance in minimally invasive tool in acoustic neurinoma surgery.Based on the experience in about 100cases done during the last5years using these additional techniques the significant benefit by using both techniques could be proven as absolutely helpful.In our patient collective until now no compli-cations could been detected regarding the use of these options as well as the effectiveness was from very high value.These,for one hand in detecting residual tumor as well as the possibility of controlling the re-sult after the resection using rigid angled endoscopes and for the other hand by the clear efficiency in us-ing neuronavigational systems in planning and performing the approach as well as doing safety drilling by removing the posterior part of the inner auditory channel.Special remarks and recommendations of the technical equipment which has been used are given as well as personal experiences in the operating room set up.Based on our results and experience the use of this two well known techniques in addition to well trained microsurgical techniques can be highly recommended.展开更多
Acoustic neurinoma usually results in impairment of .facial nerve and hearing, and rarely leads to subarachnoid hemorrhage （SAH）. In 2002, we treated a patient with bilateral acoustic neurinomas presenting as SAH.
目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌...目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌松程度和麻醉深度,在肿瘤切除过程中通过调节肌松药物和麻醉药物剂量使T4/T1维持在25%～50%,术中监测眼轮匝肌、口轮匝肌、咬肌和斜方肌自由描记肌电图和诱发肌电图,分别反应面神经、三叉神经和副神经功能。于术后1周和术后第6个月分别评估面神经功能。结果28例患者术中均成功探测到面神经走行,电刺激强度为0.1～0.3mA,术中无患者发生体动情况。术后面神经功能保留率良好,术后1周面神经House-Brackmann(H-B)功能分级为Ⅰ级者5例、Ⅱ级者13例,Ⅲ级者8例,Ⅳ级者2例;至术后6个月面神经H-B功能分级Ⅰ级者10例,Ⅱ级者12例,Ⅲ级者5例,Ⅳ级者1例。结论在听神经瘤手术过程中通过电生理监测对面神经进行保护,需要电生理、麻醉和手术医生的配合。在低水平神经肌肉接头阻滞状态下,完全可以达到确保手术安全进行及保护面神经功能的目的。展开更多
文摘The present report should summarize our experience using minimally invasive techniques in acoustic neurinoma surgery at the Neurosurgical Department, University of Vienna, Austria. Based on the experience of about 687 cases in a 20 year time period our mostly used techniques will be presented. This is a minimal invasive individual adapted approach, specified intraoperative strategy and dissection techniques (e.g. water jet dissection, ultrasonic aspirator CUSA), the use of neuronavigational systems and the use of endoscope assisted surgery. With respect to the limited space of place precise citations to further textbooks of the authors handling with this topic will be given. Finally our results using these techniques are presented and further future perspectives in the treatment of these pathology (radiosurgery) will be discussed.
文摘The present report summarizes our experience using endoscopes and neuronavigational tech-niques as an assistance in minimally invasive tool in acoustic neurinoma surgery.Based on the experience in about 100cases done during the last5years using these additional techniques the significant benefit by using both techniques could be proven as absolutely helpful.In our patient collective until now no compli-cations could been detected regarding the use of these options as well as the effectiveness was from very high value.These,for one hand in detecting residual tumor as well as the possibility of controlling the re-sult after the resection using rigid angled endoscopes and for the other hand by the clear efficiency in us-ing neuronavigational systems in planning and performing the approach as well as doing safety drilling by removing the posterior part of the inner auditory channel.Special remarks and recommendations of the technical equipment which has been used are given as well as personal experiences in the operating room set up.Based on our results and experience the use of this two well known techniques in addition to well trained microsurgical techniques can be highly recommended.
基金This study was supported by a grant from the National Natural Science Foundation of China(No.30600204)
文摘Acoustic neurinoma usually results in impairment of .facial nerve and hearing, and rarely leads to subarachnoid hemorrhage （SAH）. In 2002, we treated a patient with bilateral acoustic neurinomas presenting as SAH.
文摘目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌松程度和麻醉深度,在肿瘤切除过程中通过调节肌松药物和麻醉药物剂量使T4/T1维持在25%～50%,术中监测眼轮匝肌、口轮匝肌、咬肌和斜方肌自由描记肌电图和诱发肌电图,分别反应面神经、三叉神经和副神经功能。于术后1周和术后第6个月分别评估面神经功能。结果28例患者术中均成功探测到面神经走行,电刺激强度为0.1～0.3mA,术中无患者发生体动情况。术后面神经功能保留率良好,术后1周面神经House-Brackmann(H-B)功能分级为Ⅰ级者5例、Ⅱ级者13例,Ⅲ级者8例,Ⅳ级者2例;至术后6个月面神经H-B功能分级Ⅰ级者10例,Ⅱ级者12例,Ⅲ级者5例,Ⅳ级者1例。结论在听神经瘤手术过程中通过电生理监测对面神经进行保护,需要电生理、麻醉和手术医生的配合。在低水平神经肌肉接头阻滞状态下,完全可以达到确保手术安全进行及保护面神经功能的目的。
