显微外科手术治疗听神经瘤的价值  

The value of microsurgery for acoustic neuromas

作　　者：左良成[1] 黄权[1] 李小辉[1] 石忠松[1] 余振华[1] 罗安琪[1] 

机构地区：[1]中山大学附属第一医院神经外科,广州510080

出　　处：《中华显微外科杂志》2011年第4期287-289,共3页Chinese Journal of Microsurgery

摘　　要：目的评价听神经瘤显微外科手术切除术的临床价值。方法由枕下一乙状窦后入路施行显微手术切除的听神经瘤63例。采用先囊内后包膜的分块切除方法，磨开内耳道．切除内耳道内肿瘤。术中应用电生理监测定位面神经。结果肿瘤全切除52例．次全切除11例。面神经解剖保留58例，前庭蜗神经保留29例。63例中获得随访58例，平均随访7．2年，复发2例，无手术死亡病例，远期面神经效果：I级23例，Ⅱ级29例，Ⅲ级5例，Ⅳ级1例。听力好转9例，同术前8例。结论显微外科手术是治疗听神经瘤的主要治疗手段，在控制肿瘤和保留面、听神经功能方面可以取得满意的效果。Objective To evaluate the value of microsurgery for acoustic neuromas. Methods The author performed a retrospective study of 63 consecutive patients after vestibular schwannomas （VSs） micro- surgery with the retrosigoid approaches. The tumor was debulked firstly and dissected from surrounding neural and vascular structures by gripping the tumor capsule, and then drilled of the IAC. Intraoperative electro- physiological monitoring of facial nerve function during operation. Results Total tumor resection was achieved in 52 cases, subtotal resection was achieved in 11 cases. The anatomic preservation of facial nerve was achieved in 58 cases, the acoustic nerve was preserved anatomically in 29 cases. Fifty-eight cases re- ceived a follow-up, the mean follow-up time was 7.2 years. Two recurrent patients were found and there were no operative deaths. A long term facial nerve status：twenty-three cases were in grade I, twenty-nine cases in grade Ⅱ ,five cases in grade Ⅲ , one cases in grade Ⅳ. Hearing level had an improvement in 9 cases and remained unchanged in 8 cases. Conclusion Microsurgery treatment is the main choice of the treatment of VSs, could achieve better result in control of tumor and facial and acoustic nerve function restoration.

关 键 词：听神经瘤 听神经 面神经 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]