微小听神经瘤治疗方式探讨

目的:探讨及评估微小听神经瘤(2 cm以下)各种治疗方式及其治疗效果。方法:直径2 cm以下听神经瘤22例。均经MR I扫描诊断,分别采用中颅凹入路、乙状窦后入路、γ-刀放射治疗,对患者进行术前、术后听力及面神经功能测定。结果:完全生长在内听道的听神经瘤,经中颅凹入路手术治疗后,听力保存率83%,面神经功能完好率66%;经乙状窦后入路手术治疗后,听力保存率75%,面神经功能完好率100%;经γ-刀治疗后,听力保存率33%,面神经功能完好率为零。听神经瘤直径1 cm以下患者,经中颅凹入路手术治疗后,听力保存率83%,面神经功能完好率50%;经乙状窦后入路手术治疗后,听力保存率50%。面神经功能完好率50%;经γ-刀治疗后,听力保存率为零,面神经功能完好率也为零。结论:对于完全生长在听道的听神经瘤,最佳的治疗方式是经过中颅凹入路切除肿瘤;直径小于1 cm的听神经瘤,经中颅凹入路和乙状窦后入路切除肿瘤均可,但中颅凹入路术野开阔,利于手术操作;直径1 cm~2 cm之间的肿瘤,应采用乙状窦后入路切除肿瘤,这种入路对面神经的损伤较小。

The study on the mode of treatment for small acoustic neurinomas

Objective:To evaluate the results of treatment mode for small acoustic neurinomas,and to determine the indications for each approach.Methods: Twenty-two patients with unilateral tumors less than 2 cm in diameter were studied.Treatment includes surgery performed via the middle cranial fossa approach and via the retrosigmoid approach,r-knife.In all patients,standard pure tone air and bone conduction audiography and measurement of the speech discrimination score(SDS),facial nerve function were performed pre-and post-operatively.Results: The paients with intracanalicular tumors were treated by surgery via the middle cranial fossa approach,the hearing preservation rate was 83% in all patients,the facial nerve function was excellent or good in 66%;treated by surgery via the retrosigmoid approach,the hearing preservation rate was 75% in all patients,the facial nerve function was excellent or good in 100%;treated by r-knife,the hearing preservation rate was33% in all patients,the facial nerve function was excellent or good in 0%.In patients with tumors less than 1 cm in diameter treated by surgery via the middle cranial fossa approach,the hearing preservation rate was 83% in all patients,the facial nerve function was excellent or good in 50%;treated by surgery via the retrosigmoid approach,the hearing preservation rate was 50% in all patients,the facial nerve function was excellent or good in 50%;treated by r-knife,the hearing preservation rate was 0% in all patients,the facial nerve function was excellent or good in 0%.In patients with tumors 1~2 cm in diameter treated by surgery via the middle cranial fossa approach,the hearing preservation rate was 50% in all patients,the facial nerve function was excellent or good in 50%;treated by surgery via the retrosigmoid approach,the hearing preservation rate was 100% in all patients,the facial nerve function was excellent or good in 83%;treated by r-knife,the hearing preservation rate was 0% in all patients,the facial nerve function was excellent or good in 0%.Conclusion: To the intracanalicular acoustic tumors,the best mode of surgery is via the middle cranial fossa approach;to acoustic tumors less than 1 cm in diameter,both of the middle cranial fossa approach and retrosigmoid approach can be used,but the middle cranial fossa has broad vision,it is helpful to operate.To acoustic tumors 1~2 cm in diameter,we should via retrosigmoid approach to operate,which approach has light injury to facial nerve.