大型听神经瘤的微骨窗手术切除技巧  

Keyhole Surgery for Large Acoustic Neuromas via Retrosigmoid Approach

作　　者：王少华[1] 万经海[2] 左赋兴[2] 

机构地区：[1]安徽医科大学第一附属医院神经外科,安徽合肥230032 [2]中国医学科学院中国协和医科大学肿瘤医院神经外科,北京10002

出　　处：《中国神经肿瘤杂志》2010年第1期31-34,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的:大型听神经瘤的全切和功能保留对神经外科来说仍旧是一个挑战。本研究探讨大型听神经瘤的微骨窗手术显露、内听道磨开及囊性肿瘤切除等技巧。方法:总结41例大型听神经瘤经乙状窦后入路微骨窗(切口长6cm,骨窗直径约3cm)手术切除的临床资料,并对手术中的技巧操作进行分析。结果:肿瘤全切除39例(95%),次全切除2例(5%);面神经解剖保留36例(88%),最后一次随访时神经功能(HB分级)Ⅰ级7例(17%),Ⅱ级15例(37%),Ⅲ级5例(12%),Ⅳ～Ⅴ级9例(22%),Ⅵ级5例(12%);耳蜗神经解剖保留9例(22%),保留有效听力7例(17%)。结论:经枕下乙状窦后入路微骨窗手术切除大型听神经瘤是一种理想的微创手术方法。BACKGROUND OBJECTIVE：Total resection of large acoustic neuromas and preserving the function of normal nerve function is still a challenge for neurosurgeons.In this paper,we evaluated clinical experience and key skills of resection of large acoustic neuromas via suboccipital retrosigmoidal keyhole approach.METHOD：The clinical data of 41 patients with large acoustic neuromas resected via a suboccipital retrosigmoidal keyhole approach were summarized.RESULT：Total tumor removal was achieved in 39（95%） and subtotal removal in 2（5%）,respectively.Facial nerve was anatomically preserved in 36 patients（88%）.A House-Brackmann facial nerve Grade I was obtained in 7（17%） cases,GradeⅡ in 15（37%） cases,GradeⅢ in 5（12%） cases,Grade Ⅳ-Ⅴ in 9（22%） cases and GradeⅥ in 5（12%） case,respectively.Cochlear nerve was anatomically preserved in 9（22%） cases,and effective audition was obtained in 7（17%） cases at last follow-up.CONCLUSION：Suboccipital retrosigmoidal keyhole approach is one of reasonable minimally way for large acoustic neuromas.

关 键 词：听神经瘤 微骨窗入路 显微外科技术 

分 类 号：R739.41[医药卫生—肿瘤]