大型听神经瘤的显微外科手术切除  

Microsurgical management of large acoustic neuromas

作　　者：卢亦成[1] 丁学华[1] 胡国汉[1] 梁玉敏[1] 于明琨[1] 陈志刚[1] 骆纯[1] 刘平[1] 张光霁[1] 

机构地区：[1]第二军医大学长征医院神经外科,上海200003

出　　处：《中国微侵袭神经外科杂志》2001年第1期22-25,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结 ６４例大型听神经瘤显微外科手术的体会，探讨面、听神经功能保留的可能性和可行性。方法５９例采用单侧枕下入路，５例巨大型累及岩尖斜坡者采用经岩入路，所有病例均采用显微外科技术行肿瘤切除术。结果肿瘤全切除５６例（８８％），次全切除７例，大部切除１例。面神经解剖保留５７例（８９％），功能保留４３例（６７％）。术前尚有听力者２２例，术后听力保存者６例（２７％）手术，死亡１例（１．５％）。结论大部分大型听神经瘤采用显微外科技术可行１期全切除和面神经的保留，强调保护桥脑腹外侧静脉丛和小脑前下动脉的重要性。对大型听神经瘤亦应争取面神经和听力的保留。Objective To summarize the experiences of microsurgical management in 64 cases with large acoustic neuromas. The feasibility of facial nerve preservation and possibility of acoustic nerve preservation were evaluated. Method The unilateral suboccipital approach were used in 59 cases and transpetrosal approach were used in 5 cases in which the tumor had involved petroclival area. Result The tumors were totally removed in 56 cases (88%), subtotally removed in 7 cases and partially removed in 1 case. The anatomical facial nerve reservation had been acchieved in 57 cases (89%) and functional reservation (Ⅰ -Ⅲ grade) in 43 cases (67%). In 22 patients who had hearing function preoperatively, 6 cases (27%) preserved their hearing function after surgery. One patient (1.5%) died postoperatively. Conclusion Most of large acoustic neuromas can be totally removed in one stage by using microsurgical skill and it's possible to preserve the facial and acoustic nerves although it is very difficult to preserve the hearing function. The importance of protecting ventrolateral veniplex of pons and anterior inferior cerebellar artery are emphasized during surgical management.

关 键 词：听神经瘤 显微外科手术 治疗 

分 类 号：R739.41[医药卫生—肿瘤]