耳囊入路切除听神经瘤  

Transotic approach in acoustic neuroma surgery

作　　者：夏寅[1] 傅继弟[2] 龚树生[1] 李轶[1] 马晓波[1] 董博雅[1] 韩德民[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,教育部耳鼻咽喉头颈科学重点实验室,100730 [2]首都医科大学附属北京同仁医院神经外科,100730

出　　处：《中华神经外科杂志》2012年第8期764-767,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：首都医学发展科研基金（2009-1040）

摘　　要：目的探讨经耳囊入路在听神经瘤切除手术中的应用价值。方法回顾性分析2007年7月至2012年3月诊治的听神经瘤患者资料，术前常规进行纯音测听、面神经功能评估、颞骨CT、内耳MRI等检查，选择听力损失超过50dB或肿瘤直径〉2cm而无法保留听力且颞骨CT提示中颅窝低位、乙状窦前移、颈静脉球高位的听神经瘤患者32例，在全麻下经耳囊入路切除听神经瘤。结果肿瘤全切30例；术中面神经结构保留率100％；术后患耳丧失听力，部分患者出现头晕，经对症治疗症状缓解；无死亡、偏瘫、颅内感染等严重并发症；术后出现颅内出血和脑脊液漏各1例，重新打开术腔对症处理治愈。结论对于颞骨气化不良表现为中颅窝低位、乙状窦前移、颈静脉球高位的听神经瘤患者，如果不考虑保留听力或无保留听力价值，可选择经耳囊入路以利于彻底切除肿瘤、保留面神经功能和减少脑脊液漏。Objective To evaluate the advantages of transotie approach in acoustic neuroma surgery. Methods A retrospective analysis of patients with acoustic neuroma in our hospital between July 2007 and March 2012 were performed. These patients were undergone evaluation of PTA, facial nerve function, temporal bone CT, inner ear MRI before operation. There were 32 patients, who have a hearing loss more than 50 dB, or a tumor size larger than 2 cm, which made the preservation of hearing function impossible. Low middle cranial fossa, forward sigmoid sinus and high bulb of jugular vein were showed in preoperative CT scan. These patients were picked to have acoustic neuroma resection by transotic approach. Results The radical tumor resection rate was 94% （30/32）. The facial nerve structure preservation rate was 100%. After the surgery, all patients were single - side deaf. Some patients experienced vertigo, which was relieved after treatment. There was no severe complication such as death, hemiplegia, or intracranial infection. However, there were one case of intraeranial hemorrhage and one case of cerebrospinal fluid leakage, which were cured by revision surgery. Conclusions For those who has a worse pneumatolytic temporal bone, which presents with low middle cranial fossa, forward sigmoid sinus and high bulb of jugular vein in CT scan, if it is impossible or there is no need for the preservation of the hearing function, the transotic approach may be considered for better radical removal of tumor, preservation of facial nerve and reduction of cerebrospinal fluid leakage.

关 键 词：经耳囊入路 听神经瘤 面神经保留 脑脊液漏 

分 类 号：R739.4[医药卫生—肿瘤]