听神经瘤手术之耳科观

听神经瘤是桥脑小脑角区最常见的良性肿瘤，常见症状包括单侧感音性听力下降、耳鸣、眩晕等。手术切除是听神经瘤的主要治疗方式，常用入路包括以耳科为主的经迷路入路、经耳囊入路、扩大经迷路入路、改良经耳囊入路和颅中窝入路，以神经外科为主的枕下乙状窦后入路等。一般建议听力良好的小肿瘤选择颅中窝入路；肿瘤较大、希望保留听力者采用枕下乙状窦后入路；不考虑保留听力且为中、小型听神经瘤者，可采用经迷路入路或经耳囊入路。随着显微外科技术的发展以及术中神经监测设备的广泛应用，中、小型听神经瘤手术的面/听神经功能保留率已有显著提高，未来更多的听神经瘤患者有望在保留面/听神经功能的基础上获得治愈。

Otological Surgery of Acoustic Neuroma

Acoustic neuroma is the most common benign tumor in the internal auditory canal and cerebellopontine region.Its common clinical symptoms include unilateral sensorineural hearing loss, tinnitus and so on.Surgical resection is the predominant treatment of acoustic neuroma. The common approaches dominated by otologists include translabyrinthine approach, enlarged translabyrinthine approach, transotic approach, modified transotic approach, and middle cranial fossa approach; the approach dominated by neurosurgeons is retrosigmoid (suboccipital) approach. For small tumors with intact hearing, it is recommended to choose the middle cranial fossa approach. Those with large tumors who wish to preserve their hearing can adopt the suboccipital retrosigmoid approach; those who do not consider retaining hearing and have medium or small acoustic neuromas can adopt the translabyrinthe approach or through the transotic approach. With the development of microsurgical technology and the wide application of intraoperative nerve monitoring equipment, the retention rate of facial/cochlear nerve function for surgery of small and medium-sized acoustic neuroma has been significantly improved. In the future, more patients with acoustic neuroma are expected to be completely cured on the basis of preserving facial/cochlear nerve function.