巨大听神经瘤的显微手术治疗  

Microsurgery via retrosigmoid approach of giant vestibular schwannomas(report of 7 cases)

作　　者：胡军民 秦海林 秦汉 安学锋 HU Jun-min;QIN Hai-lin;QIN Han;AN Xue-feng(Deparment of Neurosurgery,General Hospital of Central Theater Command,PLA,Wuhan 430070,China)

机构地区：[1]中国人民解放军中部战区总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2020年第11期761-762,共2页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨巨大听神经瘤(直径>4 cm)显微手术方法及效果。方法回顾性分析2017年2月至2020年5月显微手术切除的7例巨大听神经瘤的临床资料。结果肿瘤全切除4例,近全切除1例,次全切除2例(术后3个月行伽玛刀治疗)。5例面神经解剖保留,2例术中未能解剖保留;术后面神经功能分级按H-B标准:Ⅱ级4例,Ⅲ级1例,Ⅳ级2例。术后随访4~40个月,全切除肿瘤无复发,未全切除肿瘤无进展。结论对于巨大听神经瘤,术中严格电生理监测下尽可能全切除肿瘤,必要时残留粘连紧密的脑干和面神经上肿瘤,术后辅助伽玛刀治疗,亦能取得满意的效果。Objective To explore the method of microsurgical treatment of giant vestibular schwannomas(GVS;tumor diameter,>4 cm)and its clinical efficacy.Methods The clinical data of 7 patients with GVS who underwnt microsurgery via retrosigmoid approach from February 2017 to May 2020 were analyzed retrospectively.Results Gross-total resection of tumor was achieved in 4 patients,neartotal in 1 and subtotal in 2 who were treated with gamma knife 3 months after the operation.The facial nerve was anatomically preserved in 5 patients.According to the H-B standad,the postoperative nerve function was classified as gradeⅡin 4 patients,gradeⅢin 1 and gradeⅣin 2.The follow-up(range,4~40 months)results showed no tumor recurrence or progression.Conclusions Preoperative extraventricular drainage is necessary for the patients with GVS associated with obstructive hydrocephalus.For patients with GVS,the tumors should be removed as much as possible under the strict electrophysiological monitoring during the operation.If necessary,the tumors which are tightly adhered to the brainstem and upper facial nerve can be preserved and the residual tumors can also achieve satisfactory outcomes after treatment with gamma knife.

关 键 词：巨大听神经瘤 显微手术 疗效 

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