Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most ...Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus. Conclusions The goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.展开更多
目的：探讨经扩大迷路径路大型听神经瘤切除术的显微手术技巧及效果。方法回顾性分析2013年1～4月收治的4例大型听神经瘤患者的临床资料，所有患者均采用扩大迷路径路显微手术治疗，术中面神经解剖保留3例，1例患者行面神经端端吻合。...目的：探讨经扩大迷路径路大型听神经瘤切除术的显微手术技巧及效果。方法回顾性分析2013年1～4月收治的4例大型听神经瘤患者的临床资料，所有患者均采用扩大迷路径路显微手术治疗，术中面神经解剖保留3例，1例患者行面神经端端吻合。术后随访6～10个月。结果本组4例大型听神经瘤患者肿瘤直径均≥5 cm ，最大为8 cm ，3例为重度感音神经性聋，1例高频听力下降；伴失明1例。术后复查内听道M RI显示肿瘤均全部切除，术后6个月随访时，2例面神经功能正常，1例患者面神经功能由Ⅲ级恢复到Ⅱ级，1例行面神经吻合的患者面神经功能由Ⅵ级恢复到Ⅳ级，1例伴失明的患者视力完全恢复正常。结论扩大迷路径路显微外科手术可以完全切除大型听神经瘤，并可部分或全部保留面神经功能。展开更多
Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical prese...Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical presentation is with adult-onset sensorineural hearing loss or non-pulsatile tinnitus. In some patients, this goes unnoticed, and presentation is delayed until the lesion is much larger and presents with symptoms related to mass effect. We present the case study of 63 years old gentleman, who had suspected left CPA lesion on CT head done few years ago for dizziness and left-sided facial numbness. MRI could not be done at that time due to his MRI incompatible pacemaker leading to delay in his management eventually causing loss of patient to the follow up. He later developed progressive difficulty in walking which was initially attributed to as secondary to vasovagal syncope and postural hypotension. He eventually presented to us with intractable nausea and vomiting, worsening headache and ataxia. He had an urgent CT head which showed significant growth in the lesion with compression of the surrounding structures and obstructive hydrocephalus. He was given steroids which improved his nausea and vomiting, followed by undergoing surgery in regional center leading to significant improvement in his gait within few days of surgery. He unfortunately continued to have a degree of ataxia and facial numbness. This case illustrates a rare presentation of CPA tumor with symptoms of nausea and vomiting as a result of mass effect of the growing tumor. In addition, this review also shows the importance of regularly following up the patients with suspected CPA lesions on initial scans which will help with identifying the increase in size of lesion promptly and potentially preventing advanced complications of CPA tumors. We suggest regular monitoring of these patients to timely manage the lesion and avoid the potential life-threatening complications.展开更多
目的:探讨面神经(FN)与前庭神经鞘膜瘤(VS)空间位置对于术后FN功能恢复的影响。方法:101例单侧VS患者,采用扩大迷路径路显微全切除肿瘤,观察术中FN-VS空间位置,分为4型:第1位置为FN位于VS前方,第2位置为FN位于VS前上方,第3位置为FN位于V...目的:探讨面神经(FN)与前庭神经鞘膜瘤(VS)空间位置对于术后FN功能恢复的影响。方法:101例单侧VS患者,采用扩大迷路径路显微全切除肿瘤,观察术中FN-VS空间位置,分为4型:第1位置为FN位于VS前方,第2位置为FN位于VS前上方,第3位置为FN位于VS上方,第4位置为FN位于VS后方。根据House-Brackmann面神经分级法评价患者术后7、30、90、180 d的FN功能。结果:术中FN解剖保留率达98%,术中发现FN-VS空间位置有43%为第1位置,33%为第2位置,24%为第3位置,未发现第4位置。术后180 d 73%FN功能良好,且随VS直径增大,术后FN功能良好率递减。FN-VS空间位置与术后FN功能呈显著相关,第1位置至第3位置术后FN功能良好率呈递减关系。结论:术中FN解剖保留率并不平行于术后FN功能良好率,VS直径与术后FN功能良好率相关,而FN-VS空间位置能够预测术后FN功能良好率。展开更多
文摘Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus. Conclusions The goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.
文摘目的：探讨经扩大迷路径路大型听神经瘤切除术的显微手术技巧及效果。方法回顾性分析2013年1～4月收治的4例大型听神经瘤患者的临床资料，所有患者均采用扩大迷路径路显微手术治疗，术中面神经解剖保留3例，1例患者行面神经端端吻合。术后随访6～10个月。结果本组4例大型听神经瘤患者肿瘤直径均≥5 cm ，最大为8 cm ，3例为重度感音神经性聋，1例高频听力下降；伴失明1例。术后复查内听道M RI显示肿瘤均全部切除，术后6个月随访时，2例面神经功能正常，1例患者面神经功能由Ⅲ级恢复到Ⅱ级，1例行面神经吻合的患者面神经功能由Ⅵ级恢复到Ⅳ级，1例伴失明的患者视力完全恢复正常。结论扩大迷路径路显微外科手术可以完全切除大型听神经瘤，并可部分或全部保留面神经功能。
文摘Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical presentation is with adult-onset sensorineural hearing loss or non-pulsatile tinnitus. In some patients, this goes unnoticed, and presentation is delayed until the lesion is much larger and presents with symptoms related to mass effect. We present the case study of 63 years old gentleman, who had suspected left CPA lesion on CT head done few years ago for dizziness and left-sided facial numbness. MRI could not be done at that time due to his MRI incompatible pacemaker leading to delay in his management eventually causing loss of patient to the follow up. He later developed progressive difficulty in walking which was initially attributed to as secondary to vasovagal syncope and postural hypotension. He eventually presented to us with intractable nausea and vomiting, worsening headache and ataxia. He had an urgent CT head which showed significant growth in the lesion with compression of the surrounding structures and obstructive hydrocephalus. He was given steroids which improved his nausea and vomiting, followed by undergoing surgery in regional center leading to significant improvement in his gait within few days of surgery. He unfortunately continued to have a degree of ataxia and facial numbness. This case illustrates a rare presentation of CPA tumor with symptoms of nausea and vomiting as a result of mass effect of the growing tumor. In addition, this review also shows the importance of regularly following up the patients with suspected CPA lesions on initial scans which will help with identifying the increase in size of lesion promptly and potentially preventing advanced complications of CPA tumors. We suggest regular monitoring of these patients to timely manage the lesion and avoid the potential life-threatening complications.
文摘目的:探讨面神经(FN)与前庭神经鞘膜瘤(VS)空间位置对于术后FN功能恢复的影响。方法:101例单侧VS患者,采用扩大迷路径路显微全切除肿瘤,观察术中FN-VS空间位置,分为4型:第1位置为FN位于VS前方,第2位置为FN位于VS前上方,第3位置为FN位于VS上方,第4位置为FN位于VS后方。根据House-Brackmann面神经分级法评价患者术后7、30、90、180 d的FN功能。结果:术中FN解剖保留率达98%,术中发现FN-VS空间位置有43%为第1位置,33%为第2位置,24%为第3位置,未发现第4位置。术后180 d 73%FN功能良好,且随VS直径增大,术后FN功能良好率递减。FN-VS空间位置与术后FN功能呈显著相关,第1位置至第3位置术后FN功能良好率呈递减关系。结论:术中FN解剖保留率并不平行于术后FN功能良好率,VS直径与术后FN功能良好率相关,而FN-VS空间位置能够预测术后FN功能良好率。
