双侧听神经瘤的治疗

目的：探讨双侧听神经瘤的显微外科手术和伽玛刀治疗方法，及如何保留神经功能和长期的肿瘤控制率。方法：分为两组治疗，A组12例病人直接采用伽玛刀治疗；B组14例病人采用单侧手术而对侧和术后残余肿瘤伽玛刀治疗。结果：A组病人全部保留至少一侧有用的听力，听力保留率为87．5％(2l／24，24耳中有21耳保留听力)，肿瘤控制有效率为91．7％。B组14例病人除2例病人双侧听力丧失外，12例病人均至少保留一侧有用的听力。听力保留率为46．4％(13／28，28耳中13耳听力保留)，肿瘤控制有效率为100％。结论：双侧听神经瘤的治疗应该根据病人的双侧听力情况、双侧肿瘤的大小以及颅高压及解除脑干压迫的必要性等情况，以伽玛刀为主要治疗手段配合显微外科手术切除的综合治疗，并尽力至少保留病人一侧有用的听力。

Treatment of Bilateral Acoustic Neroumas

Objective To investigate how to manage bilateral acoustic neuromas with microsurgery and Gamma knife treatment and how to preserve nerve function and gain long term tumor cotrol rate.Methods There were twenty six cases had bilateral acoustic neuromas and they were classified into two groups:twelve cases received gamma knife treatment for bilaterial tumor(group A),and fourteen cases received one side tumor resection partially or totally and then Gamma knife treatment to the residual tumor or the contralateral smaller tumor(Group B).Results Group A: all cases preserved at least one side available hearing,hearing preservation rate was 87.5% and tumor control rate was 91.7%;Group B:there were two cases lost double side hearing in fourteen cases,all others kept at least one side available hearing , hearing preservation rate was 46.4% and tumor control rate was 100%. In all the twenty six cases,hearing preservation rate was 65.4% and tumor control rate was 96.1% without death.Conclusion Management of bilaterial and unilaterial acoustic neuroma is different. For bilateral tumors, tumor size,hearing level,brainstem invasion are considered to decide treatment alternatives such as total or partial resection or Gamma knife treatment. Gamma knife should be the main treatment method.Work should be done to preserve hearing, at least one side available hearing.