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目的总结经枕下乙状窦后入路显微外科手术切除听神经瘤及面神经保护的经验和技巧,以提高肿瘤的全切率和面神经的保留率。方法 31例听神经瘤患者采用经枕下乙状窦后入路显微手术治疗,术中均行面神经电生理监测及面神经保护。结果肿瘤全切29例(93.6%),大部分切除2例(6.4%)。术中面神经解剖保留28例(90.3%),面神经功能状态H-B分级:Ⅰ~Ⅱ级22例(70.9%),Ⅲ~Ⅳ级7例(22.6%),V~Ⅵ级2例(6.5%)。无长期昏迷及死亡病例。结论娴熟的显微操作技巧和术中面神经电生理监测有助于提高肿瘤切除率及保护面神经。
Objective To summarize the experiences and techniques of microsurgical resection of acoustic neuroma and facial nerve via suboccipital sigmoid sinus posterior approach to improve the rate of full resection of the tumor and the retention rate of the facial nerve. Methods 31 patients with acoustic neuroma were treated with suboccipital sigmoid sinus posterior approach microsurgery. Facial nerve electrophysiological monitoring and facial nerve protection were performed during operation. Results The tumor was resected in 29 cases (93.6%), most of resection in 2 cases (6.4%). There were 28 cases (90.3%) with facial nerve anatomy, 22 cases (70.9%) with grade Ⅰ ~ Ⅱ, 7 cases with grade Ⅲ ~ Ⅳ (22.6%) and 2 cases with V ~ . No long-term coma and deaths. Conclusion Skillful micromanipulation techniques and intraoperative facial nerve electrophysiological monitoring can help improve tumor resection rate and protect facial nerve.