显微外科治疗巨大听神经瘤的临床研究及面神经保护  

Research on the large acoustic neuroma treatment and facial nerve protection of microsurgery

作　　者：董元训[1] 王雄伟[1] 马金阳[1] 雷志恒[1] 胡火军[1] 万志先[1] 陈健[1] 

机构地区：[1]湖北宜昌市中心人民医院(三峡大学第一临床医学院)神经外科,宜昌443003

出　　处：《中国实用神经疾病杂志》2015年第4期37-39,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨显微外科治疗巨大听神经瘤的临床研究及面神经保护。方法回顾性分析在我院进行手术治疗的87例巨大听神经瘤患者资料,均采取枕下乙状窦后入路、显微镜下切除肿瘤,其中64例患者术中采取面神经刺激仪监测,而23例患者未监测,术后随访6-38个月,记录术后疗效及对患者面神经的影响。结果 87例患者中,70例（80.46%）全切除,9例（10.34%）次全切除,其余8例（9.20%）由于肿瘤与脑干粘连紧密而广泛,仅行部分切除术;采取术中监测患者面神经保留率为95.31%,未监测患者面神经保留率为69.57%,二者比较,差异有统计学意义（P〈0.05）;术后3d患者面神经优秀率为70.11%,术后7d为26.44%,术后3个月为32.18%,术后半年为39.08%,术后1a为75.86%,与术后3d比较,术后7d、3个月及半年患者面神经优秀率显著低于术后3d;术后1a患者面神经功能与术后3d比较,差异无统计学意义（P〉0.05）。结论显微镜下枕下乙状窦后入路是治疗巨大听神经瘤有效的手术方式,能够获得较良的全切除率,术中采取面神经刺激仪监测,有利于对患者面神经的保护。Objective To investigate the large acoustic neuroma treatment and facial nerve protection of microsurgery.Methods The data of 87 acoustic neuroma patients treated by microsurgery in our hospital were retrospectively analyzed.After followed up for 6 to 38 months,the curative effect and facial nerve condition of patients were observed.Results Among 87 patients,70 cases of patients were total resection,9 cases of patients were subtotal resection and the others were only partial resection.The retention rate of facial nerve was 95.31% in intraoperative monitoring and 69.57% in no monitoring for the facial nerve of patients.Conclusion The microscope suboccipital retrosigmoid approach is an effective operation method on treating the large acoustic neuroma,and the intraoperative facial nerve monitoring can significantly protect the facial nerve of patients.

关 键 词：显微外科 巨大听神经瘤 面神经保护 

分 类 号：R739.41[医药卫生—肿瘤]