耳内镜辅助下桥小脑角手术  

Endoscope-assisted cerebellopontine angle surgery

作　　者：杨仕明[1] 韩东一[1] 杨伟炎[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科,解放军耳鼻咽喉科研究所,北京100853

出　　处：《中华耳科学杂志》2005年第2期81-85,共5页Chinese Journal of Otology

摘　　要：目的探索耳内镜在桥小脑角(CPA)手术中的应用。方法自2002年11月以来采用耳内镜结合显微镜开展CPA微创手术12例,手术均采用全麻下乙状窦后入路,并行面神经肌电位和听性脑干诱发电位术中监测。听神经瘤7例,桥小脑角面神经肿瘤2例,三叉神经鞘瘤1例,对肿瘤病例内镜主要用于检查内耳道底部有否残留病灶,探查面神经位置和走行,分离残留瘤体。舌咽神经痛1例,内镜下显露CPA和内听道口,显露后组颅神经,并确认舌咽神经,将其游离,用微型剪将之切断。半面痉挛1例,用30°内镜观察内听道口的解剖和后组颅神经的位置,在不牵拉小脑的情况下寻找对面神经形成压迫的责任血管。面神经功能按House-Brackmann分级标准评价。结果所有病例均顺利完成,无死亡病例,无并发后组颅神经损伤。听神经瘤7例,6例全切,1例绝大部分切除,残留脑干表面和内听道内的少许囊壁;均保留面神经解剖结构完整,术后一周面神经功能I级2例,II级3例(术后3个月I级),III级2例(术后3个月分别为I级和II级)。面神经鞘瘤2例,肿瘤均全切,1例保留面神经解剖结构完整,术后面神经功能III级,术后3个月II级,另1例面神经连同肿瘤一起切除,一期面神经-舌下神经吻合,术后1年面神经功能II级。三叉神经鞘瘤1例,肿瘤全切,术后一周面神经功能III级,术后3个月II级。Objective To evaluate oto-endoscope technique using in the surgery of cerebellopontine angle(CPA). Methods Twelve patients conducted with surgery of CPA under microscope with oto-endoscope- assisted in our department from Nov. 2002 to Dec. 2004 were reviewed. Of this series, there were 7 cases of acoustic neuroma(AN), 2 cases of facial nerve tumor in CPA, 1 case of trigeminal neuroma(TN), 1 case of glossopharyngeal neuralgia and 1 case of hemifacial spasm. Rigid ear endoscope was used to resect the remains of tumors inside the Internal Auditory Cannal(IAC). House-Brackmann grade system was used to evaluate the facial nerve function. Results The operation of all patients was successful, and there was no dead case and no severe complication accrued in this series. The tumors were resected completely in 6 cases of AN, 2 case of facial nerve tumor and 1 case of TN, but sub totally removed in 1 cases of AN. Of all 12 patients, 7 cases of AN, 1 case of TN, 1 case of facial nerve had obtained anatomic preservation of the facial nerves. According to House-Brackmann grade system, for AN patients 7 days after operation, there were Grade I in 2 patients, Grade II in 3 patients (Grade I after 3 months), and Grade III in 2 patients (Grade I and Grade II after 3 months, respectively), and for TN patient with Grade III but Grade II after 3 months. For patients with facial nerve tumor, the facial nerve function was Grade III in one case (Grade II post-operation 3 months) and Grade III in the other case post-operation one year with facial nerve-hypoglossal anastomosis. For 10 tumor cases, two patients were preserved the hearing level as same as that of preoperation. The symptom disappeared after surgery for the case of glossopharyngeal neuralgia patients, and for the hemificial spasm case, suffering was alleviated generally after operation. Conclusion Endoscope conbined with the microscope could play an important role to expose the anatomical structure in CPA and the tumor within the ICA to get the aim of minimal-invaded surgery,

关 键 词：桥小脑角手术 内镜辅助 面神经功能 2002年11月 听性脑干诱发电位 后组颅神经损伤 面神经肿瘤 面神经解剖 听神经瘤 三叉神经鞘瘤 肿瘤病例 结构完整 残余听力 舌咽神经痛 大部分切除 面神经鞘瘤 手术显微镜 耳内镜 微创手术 

分 类 号：R651.11[医药卫生—外科学] R653.2[医药卫生—临床医学]