内听道少见肿瘤手术中面神经保护  

Facial nerve protection in surgery for rare tumors of the internal auditory canal

作　　者：杨冰倩 解沛 徐勇[1] 杨希林[1] 任杰[1] 刘天乙[1] 江洋[1] 华清泉[1] YANG Bingqian;XIE Pei;XU Yong;YANG Xilin;REN Jie;LIU Tiany;JIANG Yang;HUA Qingquan(Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan,430060,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科,武汉430060

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第5期400-404,410,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探索内听道少见肿瘤手术过程中面神经保护的策略。方法:纳入2010至2023年就诊的235例内听道肿瘤患者,其中包括前庭神经鞘瘤、海绵状血管瘤、脑膜瘤等少见肿瘤。通过临床表现、影像学分类和治疗过程等多方面数据,详细分析少见肿瘤的特点,术前术后的面神经功能情况。结果:在所有内听道肿瘤中,前庭神经鞘瘤占91.9%;在少见肿瘤中,面神经鞘瘤占5.3%,海绵状血管瘤占26.3%,脑膜瘤占15.8%,动脉瘤占10.5%。海绵状血管瘤患者中肿瘤侵袭面神经的情况明显,而其他肿瘤与面神经边界清晰。手术过程中,对于不同类型的肿瘤,采取了个体化的手术入路和面神经保护策略,包括术中分离、肿瘤切除、面神经重建等。结论:面神经在内听道少见肿瘤手术中的保护至关重要。通过精准的术前诊断、合适的手术时机、选择性的手术入路以及术中的细致操作,可以最大限度地保护面神经功能。个体化的治疗方案和面神经功能的重建策略有望提高手术成功率,减轻患者术后面神经功能障碍的风险,从而改善患者的生活质量。Objective To explore strategies for preserving facial nerve function during surgeries for rare tumors of the internal auditory canal.Methods A total of 235 cases of internal auditory canal tumors treated between 2010 and 2023 were included,encompassing vestibular schwannomas,cavernous hemangiomas,meningiomas,and other rare tumors.Various data,including clinical presentations,imaging classifications,and treatment processes,were meticulously analyzed to delineate the characteristics of rare tumors and assess pre-and postoperative facial nerve function.Results Among all internal auditory canal tumors,vestibular schwannomas accounted for 91.9%.In rare tumors,facial nerve schwannomas constituted 5.3%,cavernous hemangiomas 26.3%,meningiomas 15.8%,and arterial aneurysms 10.5%.Significantly,patients with cavernous hemangiomas displayed pronounced invasion of the facial nerve by the tumor,in contrast to other tumor types where clear boundaries with the facial nerve were maintained.During surgery,individualized approaches and strategies for facial nerve protection were implemented for different tumor types,involving intraoperative dissection,tumor excision,and facial nerve reconstruction.Conclusion Preservation of the facial nerve is crucial in the surgical management of rare tumors of the internal auditory canal.Accurate preoperative diagnosis,appropriate timing of surgery,selective surgical approaches,and meticulous intraoperative techniques can maximize the protection of facial nerve function.Personalized treatment plans and strategies for facial nerve functional reconstruction are anticipated to enhance surgical success rates,reduce the risk of postoperative facial nerve dysfunction,and ultimately improve the quality of life for patients.

关 键 词：内听道肿瘤 面神经功能 影像学表现 神经保护与修复 

分 类 号：R745.1[医药卫生—神经病学与精神病学]