囊性听神经瘤的显微外科治疗  

Microsurgical Treatment of Cystic Acoustic Neuromas

作　　者：张方成[1] 丁金铎[1] 魏志玄[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院神经外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2010年第5期624-627,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨囊性听神经瘤的临床特点及显微手术治疗。方法对1999年1月至2009年1月武汉市协和医院收治的247例听神经瘤患者的临床资料及术后随访结果进行回顾性分析,其中囊性听神经瘤95例,占38.5%。结果 95例囊性听神经瘤中,肿瘤全切85例（89.5%）,次全切7例（7.3%）,部分切除3例（3.2%）。面神经保护率86.3%（82/95）,术后2周面神经功能House-Brackmann分级：Ⅰ-Ⅱ级65例（69.2%）,Ⅲ-Ⅳ级26例（27.6%）,Ⅴ-Ⅵ级3例（3.2%）;术后三叉神经功能障碍15例（16%）,后组颅神经功能障碍4例（4.3%）,1例（1.1%）保存听力,死亡1例（1.1%）,颅内感染3例（3.2%）。结论扎实的神经解剖知识,熟练的显微手术技巧和现代的手术器械,是成功切除囊性听神经瘤,并最大可能保全神经功能的关键。Objective To explore the clinical features and microsurgical treatment of cystic acoustic neuromas.Methods The clinical data of 247 patients with acoustic neuromas,who were treated by microsurgical procedures from January 1999 to January 2009,were analyzed retrospectively.Of the 247 cases,there were 95 cases of cystic acoustic neuromas（38.5%）.Results Total tumor resection was achieved in 85 of the 95 cases（89.5%）,subtotal resection in 7 cases（7.3%）,and partial resection in 3 cases（3.2%）.Anatomic preservation of facial nerve was achieved in 82 cases（86.3%）.For facial nerve House-Brackmann（H-B）grading 2 weeks after operation,there were 65 cases of Ⅰ-Ⅱ（69.2%）,26 cases of Ⅲ-Ⅳ（27.6%）,and 3 cases of Ⅴ-Ⅵ（3.2%）.The function of trigeminal nerve was impaired in 15 cases（16%）.The Ⅸ-Ⅻ nerves dysfunction occurred in 4 cases（4.3%）.Audition was preserved in 1 case（1.1%）.There was one death（1.1%）.Three cases（3.2%）had intracranial infection.Conclusion Modern microsurgical instruments,perfect surgical plan,appropriate surgical approach,and competent microsurgical skills are crucial for totally tumor resection and nerve preservation in the patients with cystic acoustic neuromas.

关 键 词：听神经瘤 囊性 显微手术 

分 类 号：R764.4[医药卫生—耳鼻咽喉科]