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目的报道和分析听神经瘤应用显微外科手术切除的临床效果。方法采用枕下开颅乙状窦后入路,应用显微外科手术分块切除肿瘤。术中细致观察听神经肿瘤表面蛛网膜的解剖关系,尽量保留肿瘤表面的蛛网膜。结果临床治疗71例,其中肿瘤全切除60例(84.5%),次全切11例(15.5%)。面神经解剖保留54例(76%),解剖未能保留面神经17例(24%);术后6个月随访评估面神经功能,按House-Brackmann(H-B)分级Ⅰ、Ⅱ级31例(43.7%);Ⅲ、Ⅳ级23例(32.3%);Ⅴ、Ⅵ级17例(24%)。结论应用显微外科技术切除听神经瘤,可以明显提高临床效果。囊内分块切除肿瘤、尽量保留肿瘤表面的蛛网膜是保留面神经的关键,亦是保护与肿瘤粘连的脑干及相关血管神经的关键。
Objective To report and analyze the clinical effect of microsurgical resection of acoustic neuroma. Methods Suboccipital sigmoid sinus posterior approach, the use of microsurgery block removal of the tumor. Intraoperative careful observation of the surface of arachnoid nerve tumor anatomy, try to keep the tumor surface of the arachnoid. Results Clinical treatment of 71 cases, of which 60 cases (84.5%) resection of tumor, subtotal resection in 11 cases (15.5%). Facial nerve anatomy was reserved in 54 cases (76%) and facial nerve was not preserved in 17 cases (24%). Facial function was assessed at 6 months after operation. According to House-Brackmann (HB) classification, 31 cases (43.7% 23 cases (32.3%) of grade Ⅲ and Ⅳ and 17 cases (24%) of grade Ⅴ and Ⅵ. Conclusion Microsurgical removal of acoustic neuroma can significantly improve the clinical effect. Subcapsular tumor resection, as far as possible to retain the tumor surface of the arachnoid is the key to retain the facial nerve, but also to protect the brain stem and tumor adhesion and related vascular nerves key.