76例听神经瘤手术的面、听神经保护

目的 探讨听神经瘤手术中面、听神经的保护方法及手术技巧.方法 76例首发听神经瘤患者,行枕下-乙状窦后入路显微手术切除,术中行神经电生理监测及药物保护(尼莫地平),分别于术前、术后1周及1年行面神经HB功能分级评估及听力评估.结果 76例患者中,肿瘤全切71例(93%),面神经解剖保留74例(97%),听神经解剖保留16例(21%).术后1周面神经功能评估,Ⅰ级25例,Ⅱ级32例,Ⅲ级11例,Ⅳ级4例,Ⅴ级2例,Ⅵ级2例.术后1年面神经功能评估,Ⅰ级37例,Ⅱ级24例,Ⅲ级9例,Ⅳ级3例,Ⅴ级1例,Ⅵ级2例.术后1年时听力保留者16例,占21%.结论 听神经瘤手术中进行面神经电生理监测、药物治疗及娴熟的显微外科技巧是面、听神经功能保护的关键.

Facial nerve and cochlear nerve preservation in microsurgery of acoustic neurinoma

Objective To study the skills of facial nerve and cochlear nerve reservation in acoustic neurinoma surgery. Method 76 patients with acoustic neurinoma were operated via suboccipital retrosigmoid transmeatal approach. Intraoperative electromyographic monitoring,drug treatment( Nimodipine) and microsurgical techniques were used. The facial nerve and cochlear nerve function were evaluated before and after surgery, as well as 1 year after the surgical procedure. Results Total tumor resection was achieved in 71 patients (93% ). Facial nerve was kept anatomicly intact completely in 74(97% ) patients, while the rate of cochlear nerve was 21% (16 patients). One week after surgery,an HB score of Ⅰ was documented in 25 patients,HB Ⅱ in 32.HB Ⅲ in 11 ,HB Ⅳ in 4,HB Ⅴ in 2 and HB Ⅵ in 2 patients. After 1 year,an HB score of Ⅰ was documented in 37 patients,HB Ⅱ in 24,HB Ⅲ in 9,HB Ⅳ in 3 ,HB Ⅴ in 1 and HB Ⅵ in 2 patients. One year after surgery, the hearing function was kept in 16 patients (21% ). Conclusions Effective nerve function monitoring,excellent microsurgical skills and drug treatment are very important for keeping facial nerve and cochlear nerve function in acoustic neurinoma surgery.