经枕下-乙状窦后入路显微手术切除大型听神经瘤  

Removal of large acoustic neuroma via suboccipito-retrosigmoid approach with microsurgical technique

作　　者：章翔[1] 费舟[1] 付洛安[1] 吴景文[1] 张剑宁[1] 杨利孙[1] 刘卫平[1] 顾建文[1] 易声禹[1] 王占祥[1] 贺晓生[1] 宋少军[1] 

机构地区：[1]第四军医大学西京医院全军神经外科研究所,西安710032

出　　处：《中华外科杂志》2001年第10期782-785,T002,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目 (3 9970 75 2 )

摘　　要：目的　探讨手术切除大型听神经瘤 (LAN)的最佳入径。　方法　对术前经CT或MRI证实 ,且肿瘤位于桥脑小脑角区 ,直径≥ 31mm的 2 16例LAN患者 ,采用枕下 乙状窦后入路显微手术肿瘤切除术 ;术后评估治疗效果 ,分别比较术前、后的听神经和面神经功能。　结果　肿瘤全切除率79 6 % (172例 ) ;次全切除率 15 3% (33例 ) ;部分切除率 5 1% (11例 ) ;术后病死率 1 4% (3例 )。听神经解剖保留率为 12 5 % (2 7例 ) ,出院时功能保留率为 4 2 % (A级 ,9例 ) ;面神经解剖保留率为 82 4%(178例 ) ,出院时功能保留率为 5 2 8% (House分级 ,Ⅰ～Ⅱ级 94例 )。对 187例患者平均随访 3 9年 ,其中 12 8例 (6 8 4% )恢复良好 ,44例 (2 3 5 % )恢复一般 ,15例 (8 0 % )恢复较差。在恢复较差患者中有 10例 (5 4% )肿瘤复发 (再次手术治愈 )。　结论　经枕下 乙状窦后入路显微手术切除大型听神经瘤是一种安全、有效的方法。Objective To probe the treatmen t effects of large acoustic neuroma (LAN) via a suboccipito-retrosigmoid micros urgical operation. Methods 216 patients w ith LAN in the cerebellar pons angle were confirmed by CT or MRI in our departme nt. Each tumor (diameter≥31 mm) was removed via a suboccipito-retrosigmoid mic rosurgical approach. Treatment results were evaluated and the preoperative and p ostoperative function of the acoustic nerve or the facial nerve was compared sep arately. Results The tumors were totally remov ed in 172 patients(796%), subtotally removed in 33 (153%),and partially re moved in 11 (51%). Anatomic preservation of the acoustic nerve was achieved in 27 patients (125%),and functional preservation in 9 patients (Grade A, 42% ) at discharge. Anatomic preservation of the facial nerve was achieved in 178 pa tients (824%) and functional preservation in 94 (House Grade, Grade Ⅰ～Ⅱ, 52 8%) at discharge. Follow-up observation (Median: 39 years) of 187 patients revealed good recovery in 128 patients (684%), fair recovery in 44 (235%), a nd poor recovery in 15 (80%). Late recurrence was noted in those with poor rec overy (10 patients, 54%) (cured by second treatment). Conclus ion It is a safe and effective way to remove LAN via suboccipit o-retrosigmoid approach with microsurgical technique.

关 键 词：听神经肿瘤 手术入路 LAN 显微外科手术 经枕下-乙状窦后入路 

分 类 号：R739.41[医药卫生—肿瘤] R730.56[医药卫生—临床医学]