颅内听神经瘤手术治疗策略及并发症分析:附111例病例回顾  

Analysis of surgical strategies and complications for acoustic neuroma:111 cases review

作　　者：赵澎[1] 张鹏飞[1] 韩利江[1] 李鑫[1] 张俊廷[1] Zhao Peng Zhang Pengfei Han Lijiang Li Xin Zhang Junting(Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中国微侵袭神经外科杂志》2017年第9期389-392,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：北京市自然科学基金项目(编号:7162034)

摘　　要：目的探讨颅内听神经瘤的手术治疗策略及相关并发症。方法回顾性分析111例听神经瘤病人的临床资料,术前均行头颅MRI及岩骨CT薄层扫描,应用显微镜下枕下乙状窦后入路手术,术中采用面神经和听力监测。术后1周、3个月、6个月进行复查,并统计分析面神经恢复情况、听神经功能保护及病人症状改善情况。结果本组肿瘤全切除率达100%。本组面神经保留率100%,术后6个月面神经功能较术后1周明显好转(P<0.05)。本组术中听神经保留率100%,术后听力明显改善28例,与术前基本一致73例,听力下降10例。随访中失访5例,余病人术后临床症状均较术前有不同程度改善。术后切口脑脊液漏2例,无手术死亡和复发病例,未发生严重术后并发症。结论随着听神经瘤手术方式及手术技巧的改进,采用枕下乙状窦后入路手术切除肿瘤结合术中神经功能监测,可提高术中面听神经保留率、减少术后并发症、改善预后。Objective To investigate the surgical strategies and related complications of acoustic neuroma.Methods Clinical data of 111 patients with acoustic neuroma undergoing microsurgery via suboccipital retrosigmoid approach were analyzed retrospectively.MRI and petrous bone CT scan before the operation,and facial nerve and hearing monitorings during the operation were performed.Facial nerve recovery,protection of auditory nerve function and improvement of the symptoms were analyzed statistically 1 week and 3,6 months after the operation.Results The tumor resection rate,facial nerve and auditory nerve reservation rate all achieved 100%.Facial nerve function at 6 months after operation was significantly better than that at 1 week after operation（P〈0.05）.Hearing improvement was achieved in 28 patients after operation,the same as preoperation in 73 and hearing loss in 10.During follow-up period,5 patients were lost to follow-up,and the clinical symptoms all were improved to different degrees after operation in other patients.Cerebrospinal fluid leakage occurred in 2 patients,while neither patient died or recurred,nor serious postoperative complications occurred.Conclusions With the improvement of surgical method and technique for acoustic neuroma,the microsurgery via suboccipital retrosigmoid approach combined with intraoperative nerve function monitoring can improve intraoperative facial and auditory nerve preservation rate,reduce postoperative complications and improve prognoses.

关 键 词：神经瘤 听 入路 经枕下乙状窦后 策略 手术治疗 手术后并发症 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]