内听道海绵状血管瘤的临床资料分析

摘要：目的探讨内听道海绵状血管瘤的诊断和治疗方法。方法回顾性分析2006年1月~2013年12月6例内听道海绵状血管瘤患者的临床资料，对患者的临床表现、影像学表现、手术方法及效果进行分析。6例患者均进行了CT与MRI检查，其中5例患者伴有面神经功能障碍，对此5例患者进行了手术治疗，对1例面神经功能正常的患者采取严密随访策略。结果6例患者术前均出现了听力下降与耳鸣，其中5例手术患者病理确诊为内听道海绵状血管瘤。手术径路包括4例迷路径路与1例颅中窝径路，术中发现肿瘤与面神经和（或）前庭蜗神经粘连，难以分离，其中3例由于肿瘤无法与面神经分离行面神经切除重建术，2例患者面神经解剖保留。术后5例患者患侧听力均丧失，术后1年行MRI复查肿瘤无残留，面神经功能均有不同程度提高。随访患者行MRI检查示肿瘤未生长。结论内听道海绵状血管瘤术前可以根据临床表现与特征性影像学表现作出诊断；相较于内听道其他常见肿瘤，海绵状血管瘤更易侵犯神经，因此手术时机的选择应更加积极；迷路径路相较于乙状窦后径路或颅中窝径路在处理内听道海绵状血管瘤上有优势，比较容易进行面神经定位与重建。

Analysis of clinical data on cavernous hemangioma of internal auditory canal

Abstract:ObjectiveTo discuss the diagnosis and treatment of cavernous hemangioma of internal auditory canal (IAC).MethodsA retrospective analysis of 6 cases with cavernous hemangioma of IAC diagnosed between Jan 2006 and Dec 2013 was conducted. Clinical manifestations, radiological appearances, surgical approaches and curative effects were analyzed. All patients received computed tomography (CT) and magnetic resonance imaging (MRI), and five of them received surgical tumor removal and one without facial nerve problems was followed with wait and scan policy.ResultsAll patients had presented with sensorineural hearing loss and tinnitus, and five of them were diagnosed by pathologic manifestations. Four patients received tumor removal via translabyrinthine approach and one with useful hearing via middle cranial fossa approach. Tumors were adherent to VII and/or VIII cranial nerve and difficult to dissect from nerve during surgery, and facial nerve could not be separated from tumor in 3 cases and primary end to end anastomosis was performed. Intact facial nerve preservation was achieved in 2 patients during surgery. No useful hearing was preserved in all 5 patients. Follow up period was performed for at least one year, and MRI scanning showed no evidence of tumor regrowth. All the operated patients got facial nerve function recovery in various degrees.ConclusionCavernous hemangioma of IAC can be diagnosed preoperatively by typical clinical manifestations and radiological appearance. The selection of tumor removal should be more aggressive than other common tumors of IAC because cavernous hemangioma has an intranervous infiltration growth manner. Translabyrinthine approach seems to be appropriate because the facial nerve can be located and reconstructed easily.