微小听神经瘤治疗方式探讨  

The study on the mode of treatment for small acoustic neurinomas

作　　者：贾栋[1] 高国栋[1] 李永林[1] 赵振伟[1] 

机构地区：[1]第四军医大学唐都医院神经外科,陕西西安710038

出　　处：《现代肿瘤医学》2006年第8期939-942,共4页Journal of Modern Oncology

摘　　要：目的:探讨及评估微小听神经瘤(2 cm以下)各种治疗方式及其治疗效果。方法:直径2 cm以下听神经瘤22例。均经MR I扫描诊断,分别采用中颅凹入路、乙状窦后入路、γ-刀放射治疗,对患者进行术前、术后听力及面神经功能测定。结果:完全生长在内听道的听神经瘤,经中颅凹入路手术治疗后,听力保存率83%,面神经功能完好率66%;经乙状窦后入路手术治疗后,听力保存率75%,面神经功能完好率100%;经γ-刀治疗后,听力保存率33%,面神经功能完好率为零。听神经瘤直径1 cm以下患者,经中颅凹入路手术治疗后,听力保存率83%,面神经功能完好率50%;经乙状窦后入路手术治疗后,听力保存率50%。面神经功能完好率50%;经γ-刀治疗后,听力保存率为零,面神经功能完好率也为零。结论:对于完全生长在听道的听神经瘤,最佳的治疗方式是经过中颅凹入路切除肿瘤;直径小于1 cm的听神经瘤,经中颅凹入路和乙状窦后入路切除肿瘤均可,但中颅凹入路术野开阔,利于手术操作;直径1 cm^2 cm之间的肿瘤,应采用乙状窦后入路切除肿瘤,这种入路对面神经的损伤较小。Objective：To evaluate the results of treatment mode for small acoustic neurinomas, and to determine the indications for each approach. Methods： Twenty-two patients with unilateral tumors less than 2 cm in diameter were studied. Treatment includes surgery performed via the middle cranial fossa approach and via the retrosigmoid approach ,r- knife. In all patients, standard pure tone air and bone conduction audiography and measurement of the speech discrimination score （SDS） ,facial nerve function were performed pre-and post-operatively. Results： The paients with intracanalicular tumors were treated by surgery via the middle cranial fossa approach , the hearing preservation rate was 83% in all patients, the facial nerve function was excellent or good in 66% ; treated by surgery via the retrosigmoid approach , the hearing preservation rate was 75% in all patients, the facial nerve function was excellent or good in 100% ; treated by r-knife, the hearing preservation rate was33% in all patients, the facial nerve function was excellent or good in 0%. In patients with tumors less than 1 cm in diameter treated by surgery via the middle cranial fossa approach , the hearing preservation rate was 83% in all patients ,the facial nerve function was excellent or good in 50% ; treated by surgery via the retrosigmoid approach , the hearing preservation rate was 50% in all patients, the facial nerve function was excellent or good in 50% ; treated by r - knife, the hearing preservation rate was 0% in all patients, the facial nerve function was excellent or good in 0%. In patients with tumors 1-2 cm in diameter treated by surgery via the middle cranial fossa approach , the hearing preservation rate was 50% in all patients , the facial nerve function was excellent or good in 50% ; treated by surgery via the retrosigmoid approach , the hearing preservation rate was 100% in all patients, the facial nerve function was excellent or good in 83% ; treated by rknife, the hearing preservation rate was 0% in all patients, the facial

关 键 词：听神经瘤 乙状窦后入路 中颅凹入路 面神经 

分 类 号：R739.4[医药卫生—肿瘤]