桥小脑角区大型肿瘤显微手术及面神经保护方法探讨  

Examination of Microsugical Operatios on Patients with Tumors in Cerebelloponfine Angle Area and of Methods on Preservation of Facial Nerves

作　　者：汪恩焕[1] 朱成[1] 马骥[1] 周钟阳[1] 张妮娜[1] 王茂林[1] 王宏伟[1] 王洪飞[2] 周家利[2] 乔慧[3] 

机构地区：[1]安徽省蚌埠市中心医院神经外科,233000 [2]蚌埠坦克学院医院,233000 [3]北京市神经外科研究所,100050

出　　处：《中华全科医学》2011年第9期1357-1358,共2页Chinese Journal of General Practice

摘　　要：目的探讨桥小脑角区大型肿瘤显微手术方法及在手术过程中面神经保护的手术技巧以及应用面神经电生理监测方法应用后的临床效果。方法回顾性分析经显微外科手术切除桥小脑角区大型肿瘤23例的临床资料,男性11例,女性12例;年龄19～71岁,平均39.6岁;病程3个月～2年。主要表现为桥小脑角综合征和颅内压增高征。耳鸣听力下降12例,头痛、恶心及呕吐10例,行走不稳4例,面部麻木7例,三叉神经痛2例,面瘫6例。其中5例行面神经术中监测。结果本组23例显微镜下全切除为18例,次全切除5例。18例术中无神经电生理监测解剖保留面神经12例,术后3月后面瘫不能恢复的7例,5例行面神经电生理监测,解剖保留面神经5例,术后3月后面瘫不能恢复的1例,23例总面神经解剖保留率73.9%,面神经功能保留率为65.2%,无死亡病例,面瘫8例。结论手术入路的正确选择、娴熟的显微外科操作技术应用,术中应用面神经监测技术,能有效地保护桥小脑角周围的重要结构及面神经功能。Objective To explore the microsurgery approaches employed in operations dealing with tumors in abnormal size in cerebelloponfine angle area, and the relative techniques for the preservation of facial nerves in the same operations as well as the clinical performance as the result of the employment of the method of monitoring facial nerves in operations. Methods Clinical data with regard to 23 patients who were resected of tumors in abnormal size in their cerebelloponfine angle area after operations conducted with microsurgical techniques were examined and analyzed. Results Among the 23 patients, 18 were resected completely of their tumors and 5 of them were partly resected with the assistance of microscope. In the 18 cases mentioned above, the facial nerves of 12 patients were anatomically preserved in operations supported by the technique of eletroneurophilogy monitoring,7 couldn＇t be cured of their facial paralysis 3 months after their operations ,5 were monitored on their facial nerves ,5 were anatomized and their facial nerves were preserved, and 1 couldn＇ t be cured of his facial paralysis 3 months after his operation. For all the 23 patients, the cases in which facial nerves were anatomically preserved account for 73.9% and the cases in which the function of patients facial nerves were preserved account for 65.2%, with no occurrence of the incident of death during operations and 8 unlucky enough to have to suffer facial paralysis. Conclusion An appropriate method combined with effective application of techniques considering microsurgery and monitoring facial nerves in the process of operating was significant in terms of preseving the essential structures around the cerebelloponfine angle area and keeping facial nerves functioning well.

关 键 词：桥小脑角 肿瘤 显微手术 面神经保护 

分 类 号：R739.41[医药卫生—肿瘤]