大型前庭神经鞘瘤手术治疗效果分析  

Analysis of surgical results of large vestibular schwannoma

作　　者：宋刚[1] 吴晓龙 林庆堂 李茗初[1] 郭宏川[1] 汤劼 肖新如 陈革[1] 鲍遇海[1] 梁建涛[1] SONG Gang;WU Xiao-long;LIN Qing-tang(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《临床神经外科杂志》2021年第3期295-298,304,共5页Journal of Clinical Neurosurgery

基　　金：北京市医管局“扬帆计划”(XMLX201821)。

摘　　要：目的分析大型前庭神经鞘瘤(直径≥3 cm)手术治疗的效果及面神经损伤预防。方法回顾性分析99例直径≥3 cm前庭神经鞘瘤患者的临床资料。患者均行乙状窦后入路手术切除肿瘤,分析患者的肿瘤切除程度、手术并发症以及面神经功能。结果本组患者中肿瘤全切除者76例(76.8%),近全切除者19例(19.2%),次全切除者4例(4.0%);共有7例患者(7.1%)未能解剖保留面神经。70例肿瘤全切且面神经解剖保留的患者中,术后3个月时面神经功能良好者50例(71.4%),面神经功能损伤者20例(28.6%)。术后1例患者(1.0%)发生术区脑出血,但无明显临床症状,予以保守治疗好转;18例患者(18.2%)发生颅内感染,经更换抗生素及腰椎穿刺治疗后治愈;3例患者(3.0%)出现脑脊液鼻漏,经绝对卧床保守治疗后症状消失;1例患者(1.0%)出现后组颅神经损伤及共济失调,3例患者(3.0%)出现共济失调,均经康复治疗1个月后症状缓解。结论大型前庭神经鞘瘤(直径≥3 cm)的手术全切除率较高,但完好保留面神经功能较困难。故术中如发现全切肿瘤对面神经功能损伤较大,可以在肿瘤与面神经粘连最紧密处残留薄层肿瘤,以保留患者的面神经功能。Objective To analyze the effect of surgical treatment of large vestibular schwannoma(diameter≥3 cm)and the prevention of facial nerve injury.Methods The clinical data of 99 patients with vestibular schwannoma≥3 cm in diameter were analyzed retrospectively.The extent of tumor resection,surgical complications and facial nerve function were analyzed.Results In this group,76(76.8%)had total resection,19(19.2%)had near total tumor resection,and 4(4.0%)had subtotal resection.7(7.1%)failed to preserve the facial nerve.Among the 70 patients with total tumor resection and facial nerve preservation,50(71.4%)had good facial nerve function at 3 months after operation,and 20(28.6%)had facial nerve injury.1 patient(1.0%)had cerebral hemorrhage in the operation area,but no obvious clinical symptoms.Intracranial infection occurred in 18 patients(18.2%),which were cured by changing antibiotics and lumbar puncture.3(3.0%)had cerebrospinal fluid rhinorrhea,and the symptoms disappeared after conservative treatment.1 patient(1.0%)developed posterior cranial nerve injury and ataxia,and 3 patients(3.0%)developed ataxia.The symptoms were relieved after 1 month of rehabilitation treatment.Conclusions The total resection rate of large vestibular schwannomas(diameter≥3 cm)is high,but it is difficult to preserve facial nerve function.Therefore,if it is found that the facial nerve function is seriously damaged during total resection,a thin layer of tumor can be left at the place where the tumor adheres to the facial nerve most closely,so as to preserve the facial nerve function of patients.

关 键 词：神经鞘瘤 前庭神经 面神经损伤 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤]