30°神经内镜处理内听道残余听神经瘤的应用  

Application of 30° endoscope-assisted resection of residual vestibular schwannoma in the internal acoustic meatus

作　　者：郭宏川[1] 宋刚[1] 李茗初[1] 鲍遇海[1] 张秋航[1] 

机构地区：[1]首都医科大学宣武医院神经外科颅底外科中心,北京100053

出　　处：《中国微侵袭神经外科杂志》2016年第8期354-356,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨30°神经内镜处理内听道内残余听神经瘤的应用。方法通过乙状窦后入路,术中使用30°内镜辅助显微镜切除内听道内残余听神经瘤86例,手术前后均进行增强MRI检查,面神经功能评估。结果 86例肿瘤均完全切除,面神经解剖保留74例（86%）。随访3～24个月,3.0T增强MRI复查65例,未发现肿瘤复发。在面神经解剖保留的74例病例中,根据House-Brackmann分级标准,面神经功能Ⅰ级33例,Ⅱ级25例,Ⅲ级7例,Ⅳ级6例;3例面神经功能未恢复,行面神经-舌下神经吻合术。结论通过乙状窦后入路,术中使用30°内镜辅助显微镜处理内听道内残余听神经瘤的方法,克服显微神经外科手术某些解剖区域的死角,最大限度减少手术损伤,可全切听神经瘤。Objective To explore application of the 30° endoscope-assisted resection of residual vestibular schwannoma in the internal acoustic meatus. Methods The 30° endoscope-assisted microscope was used to resect residual vestibular schwannoma in the internal acoustic meatus via retrosigmoid approach. The preoperative and postoperative enhanced MRIs were implemented and facial nerve function was evaluated. Results Vestibular schwannoma was removed completely in 86 patients. The facial nerves were anatomically preserved after tumor removal in 74 （86%） patients. Follow up was performed for 3 to 24 months, 3.0 T enhanced MRI showed no recurrent in 65 cases. In the 74 cases of anatomically preserved facial nerve, according to House-Brackmann grading, facial nerve function grade I was seen in 33 cases, grade Ⅱ in 25, grade Ⅲ in 7, grade Ⅳ in 6 and facial nerve fimction was not restored in 3 patients with facial nerve-hypoglossal nerve anastomosis. Conclusions 30° endoscope-assisted resection of residual vestibular schwannoma in the internal acoustic meatus via retrosigmoid approach can overcome the the blind angle of some anatomical regions in microneurosurgery, minimize surgical injury, and completely remove vestibular schwarmoma.

关 键 词：听神经瘤 残余 内听道 神经内镜 

分 类 号：R739.4[医药卫生—肿瘤]