乙状窦后入路听神经瘤术中内听道的个体化处理  

Optimization strategy for individualized management of the internal auditory canal during retrosigmoid approach for acoustic neuroma

作　　者：尹浩扬 辛运 蒋涛[1] 吴越[1] 程崇杰[1] 夏海坚[1] 张文韬 孙晓川[1] 唐文渊[1] 徐胜生[2] 钟东[1] Yin Haoyang;Xin Yun;Jiang Tao;Wu Yue;Cheng Chongjie;Xia Haijian;Zhang Wentao;Sun Xiaochuan;Tang Wenyuan;Xu Shengsheng;Zhong Dong(Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Radiology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]重庆医科大学附属第一医院放射科,重庆400016

出　　处：《中华脑科疾病与康复杂志（电子版）》2023年第6期364-368,共5页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的探讨显微神经外科手术处理内听道内的个体化策略,以达到患者利益最大化。方法回顾性分析重庆医科大学附属第一医院神经外科自2021年9月至2022年8月行神经内镜辅助经枕下乙状窦后入路显微外科手术治疗的27例听神经瘤患者的临床资料。根据患者肿瘤长入内听道的程度及身体基础情况,分为内听道磨开组(18例)和掏刮组(9例),比较2组患者的手术时间、肿瘤的切除程度、面神经的保留以及术后感染情况。结果内听道磨开组中肿瘤完全切除9例,近全切除7例,次全切除2例;掏刮组中肿瘤完全切除2例,近全切除5例,次全切除2例;2组患者的近全及以上切除率比较,差异无统计学意义(P>0.05)。术中镜下观察所有患者面神经均得到解剖保留。2组患者的手术时间和住院费用比较,差异均有统计学意义(P<0.05)。内听道磨开组患者术后3个月House-Brackmann(H-B)Ⅰ~Ⅱ级9例,Ⅲ级7例,Ⅳ级2例;掏刮组患者术后3个月H-BⅠ~Ⅱ级5例,Ⅲ级4例,Ⅳ级0例。术后发生颅内感染4例,其中内听道磨开组3例,掏刮组1例。结论相对于内听道磨开法,掏刮法的手术耗时更短,术后并发症发生率相对更低,患者的住院天数和医疗费用更少。通过精准的术前评估,对合适的患者采用掏刮法处理内听道内肿瘤更利于提高疗效。Objective To explore the individualized strategy of micro neurosurgery in the internal auditory canal(IAC)in order to maximize the benefits of patients.Methods A retrospective analysis was conducted on the clinical data of 27 patients with acoustic neuroma treated by neuroendoscopy-assisted microsurgery via suboccipital retrosigmoid approach from September 2021 to August 2022 in the Neurosurgery Department of The First Hospital of Chongqing Medical University.According to the extent of tumor growth into the internal auditory canal and the physical foundation of the patients,the patient were divided into the drilling open IAC group(18 cases)and the scraping group(9 cases).The operative time,the degree of tumor resection,the preservation of the facial nerve,and the control of postoperative infections were compared between the two groups.Results Nine patients had complete resection of the tumor by drilling open the posterior superior wall of the internal auditory canal,7 patients had near-total resection,and 2 patients had subtotal resection(tight adhesion to the brainstem).Two patients had complete resection of tumor by scraping method,5 patients had near-total resection and 2 patients had subtotal resection.There was no statistically significant difference in the near-total and above resection rates between the 2 groups of patients(P>0.05).Intraoperative microscopic observation of the facial nerve was anatomically preserved in all patients.Comparing the operation time and hospitalization expenses between the two groups of patients,the differences were statistically significant(P<0.05).According to the House-Brackmann(H-B)facial nerve function classification,the facial nerve function in the three-month postoperative period was gradeⅠ-Ⅱin 9 patients,gradeⅢin 7 patients,and gradeⅣin 2 patients by the drilling method,and gradeⅠ-Ⅱin 5 patients,gradeⅢin 4 patients,and gradeⅣin 0 patients by the scraping method.The Intracranial infection occurred in 4 cases after surgery,including 3 cases in the drilling

关 键 词：听神经瘤 枕下乙状窦后入路 内听道 掏刮法 

分 类 号：R651.3[医药卫生—外科学]