摘要
目的 探讨经枕下-乙状窦后入路显微手术切除大型听神经瘤的临床疗效和意义。方法 采用枕下乙状窦后入路对49例大型（≥4 cm）听神经瘤行显微手术切除,单侧枕下乳突后“S”形皮肤切口,铣刀骨瓣成形,显微镜下行肿瘤囊内逐步切除,最后分离内听道部分,锐性剥离面神经上残存肿瘤。术前及术后分别进行面神经和听神经的功能评估。结果 肿瘤全切除45例（92%）,次全切除4例（8%）,全组无死亡病例。面神经解剖保留42例（86%）,术后2周功能保留36例（73%）;听神经解剖保留7例（14%）,术后2周功能保留3例（6%）。1例手术区血肿再手术清除。37例随访0.5～5年,平均2.8年,肿瘤无复发,均参加正常工作和学习。结论 枕下乙状窦后入路显微手术是切除大型听神经瘤的较好方法,肿瘤的全切率高,死亡率和病残率低,并能有效地保留面、听神经的功能。
Objective To evaluate the safety and efficacy of microsurgical resection of large acoustic neurinoma via the suboccipital retrosigmoid approach. Methods Forty-nine patients with large acoustic neurinoma （ ≥4 cm） underwent microsurgical resection through suboccipital retrosigmoid approach. The craniotomy was performed by way of an unilateral S-shaped suboccipital incision. With microsurgical techniques the outmost layer of the arachnoid membrane was preserved in order to avoid damaging to the surrounding vital structures. The tumor was resected intracapsularly from the superior pole and the internal auditory meatus was finally opened. The last pieces of tumor were removed by sharp dissection from the facial nerve bidirectionally, and were resected cautiously in a piecemeal fashion. Results Of the 49 patients, 45 patients （92%） received a total resection of the tumors, and 4 patients （8%） subtotal resection. No patients died. The facial nerve was preserved anatomically in 42 patients （86%） and functionally in 36 patients （73%）. The acoustic nerve was preserved anatomically in 7 patients （ 14% ） and functionally in 3 patients （6%）. One patient experienced a postoperative haematoma, and a re-operation was required. No recurrence was seen in 37 patients during a follow-up for 6 months - 5 years （mean, 2. 8 years）. These patients had recovered for normal work and daily activities. Conclusions Microsurgical operation through suboccipital retrosigmoid approach is a favorable treatment for large acoustic neurinomas. The procedure can improve the rate of total resection, decrease the morbidity and mortality, and effectively protect the function of the acoustic and facial nerves.
出处
《中国微创外科杂志》
CSCD
2007年第7期653-655,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
枕下-乙状窦后入路
听神经瘤
显微手术
Suboccipital retrosigmoid approach
Acoustic neurinoma
Microsurgery
