神经内镜辅助及显微镜下治疗小型听神经瘤的对比研究  

Comparative analysis of neuroendoscope-assisted microsurgery and microscope treatment for small acoustic neuroma

作　　者：姚晓辉[1] 吉宏明[1] 张世渊[1] 丁新民[1] 张刚利[1] 张艳[1] 

机构地区：[1]山西省人民医院神经外科,030012

出　　处：《中华医学杂志》2014年第35期2757-2759,共3页National Medical Journal of China

摘　　要：目的 探讨神经内镜辅助及显微镜手术经乙状窦后入路治疗小型听神经瘤的方法及效果.方法 对山西省人民医院2008至2013年入住的20例听神经瘤患者行神经内镜辅助及22例行显微镜锁孔手术切除,术中应用面神经监测及30°神经内镜辅助及显微镜.内镜辅助组用神经内镜多方位观察面神经及内听道情况,显微镜组直视下手术.对比两种方法对面神经的损伤及内听道磨除程度的影响.结果 20例听神经瘤经神经内镜辅助手术均全切除并面神经保留.术后面神经功能Ⅰ级6例,Ⅱ级10例,Ⅲ级4例;16例内听道未磨除,4例仅磨除2～3 mm.22例经显微镜切除的听神经瘤,术后面神经功能Ⅰ级5例,Ⅱ6级例,Ⅲ级8例,Ⅲ～Ⅳ3例;10例内听道未磨除,12例至少磨除3 mm;两种方法均无脑脊液漏等并发症.结论 神经内镜局部放大、良好照明及其广角和成角的特点在治疗听神经瘤过程中能有效弥补显微镜的不足,从而减轻面神经的损伤及减少内听道的磨除,提高手术疗效.Objective To explore the outcomes of surgery for the treatment of small acoustic neuroma by the neuroendoscope-assisted microsurgery and microscope.Methods From 2008 to 2013,42 patients with small acoustic neuroma underwent neuroendoscope-assisted microsurgery （n =20） and microscopic tumoural resection （n =22）.Neurophysiological monitoring,30-degree rigid neuroendoscope and microscope were employed intra-operatively.For the endoscope group,facial nerve and inner acoustic meatus could be visualized distinctly in each aspect,as for the microscope group,microscopic operation could be accomplished directly.The damage extents of facial nerve and inner acoustic meatus were compared between two groups.Results Total removal of acoustic neuroma and conservation of facial nerve were achieved in all patients.For the neuroendoscope-assisted group,the postoperative facial functions were Grade Ⅰ （n =6）,Grade Ⅱ （n =10） and Grade Ⅲ （n =4）.Internal acoustic canal was drilled 2-3 mm in 4 patients and no drilling in others.For the microscope group,Grade Ⅰ （n =5）,Grade Ⅱ] （n =6）,Grade Ⅲ （n =8） and Grade Ⅲ-Ⅳ （n =3）.Internal acoustic canal was drilled at least 3 mm in 12 patients and no drilling in others.No complication such as cerebrospinal fluid leakage occurred during the followups.Conclusion Endosocopic operation of acoustic neuroma surgery is superior to microscopic operation in terms of magnification,illumination,wide-angel and angulation.And the former procedure may yield better outcomes through alleviating the damage of facial nerve and decreasing the drilling degree of inner acoustic meatus.

关 键 词：神经内镜 电生理监测 听神经瘤 桥脑小脑角 

分 类 号：R739.4[医药卫生—肿瘤]