经枕下乙状窦后入路单独内镜手术切除听神经鞘瘤(附10例报告)

目的总结经枕下乙状窦后入路单独内镜手术切除听神经鞘瘤的经验。方法回顾性分析10例听神经瘤患者的临床资料,均在内窥镜视屏图像引导下经枕下乙状窦后入路手术切除肿瘤。结果术后MRI显示肿瘤完全切除5例、次全切除3例、大部切除2例。术后随访6个月,发生单侧轻微面瘫2例、单侧面部麻木1例。结论采用经枕下乙状窦后入路单独内窥镜手术切除听神经鞘瘤具有微创、简便、舒适和疗效好等优点。     

神经内镜辅助显微手术切除听神经瘤与术中面神经保护

目的探讨神经内镜辅助显微手术下的听神经瘤切除手术术中的面神经保护。方法分析36例听神经瘤手术中神经内镜的使用情况,了解其对内听道肿瘤的暴露,面神经的保护方面的作用以及与显微镜的配合。结果全部手术的36例患者中,31例全切,5例部分切除,0例活检。结论神经内镜辅助显微手术下的听神经瘤切除手术技术简便﹑安全和有效。神经内镜手术更加微创,在听神经瘤切除方面具有优势,可有效保护面神经。     

神经内窥镜辅助显微手术治疗巨大听神经瘤

目的　探讨神经内窥镜辅助的巨大听神经瘤显微手术治疗的效果及手术技巧。方法　 2 0例直径 4cm以上的听神经瘤 ,行一侧枕下乙状窦后入路显微切除 ,同时以神经内窥镜辅助配合。结果　肿瘤全切除 18例 ,面神经保留 16例 ,耳蜗神经解剖学保留 6例 ;术后近期并发症 5例 ,死亡 1例 ,面神经和耳蜗神经功能随访有不同程度的恢复。结论　一定的手术技巧是巨大听神经瘤手术治疗取得良好效果的关键 ,神经内窥镜的辅助使手术更加安全、有效     

神经内窥镜辅助显微手术切除颅内肿瘤

目的探讨神经内窥镜在辅助颅内肿瘤显微手术中的临床应用价值。方法通过近3年来对颅内听神经瘤、胆脂瘤、大囊小结节型血管网织细胞瘤和较大的脑室内室管膜瘤等15例患者,进行内窥镜辅助显微手术。结果7例听神经瘤患者肿瘤(包括内听道内)全部切除,保存了原有内听道结构,面神经颅内段解剖保留5例(5/7),而内听道段全部保留(7/7)。3例胆脂瘤患者中,2例全切除,1例次全切除。3例大囊小结节型血管网织细胞瘤共6个肿瘤结节,全部切除。2例室管膜瘤中有1例镜下全切除,另1例次全切除。所有15例患者中有13例获得6月至2年随访,疗效满意。结论某些显微镜下视野无法到达的肿瘤病灶部分,在内窥镜辅助下得以安全切除成为可能。     

手术治疗复发听神经瘤的临床分析

目的 研究复发听神经瘤的手术方法和疗效。方法 回顾性分析27例复发听神经瘤病人的临床诊治资料。手术方法采用原手术切口枕下乙状窦后入路25例，颞下入路2例；术中使用内窥镜辅助切除肿瘤10例。结果 27例再手术病人中肿瘤全切除21例，次全切除4例，大部分切除2例。无死亡病例。12例在手术后面神经得到解剖保留。有2例手术后出现伤口脑脊液漏，1例出现脑脊液耳漏，经腰穿置管引流等保守治疗后好转。2例于半年内复诊时仍伴有明显脑积水，行分流手术后症状改善。术后按GOS评估，15例患者正常生活和工作，8例可做轻量工作或生活能自理，4例需要他人照顾。结论 虽然复发听神经瘤与面听神经、脑干等结构有不同程度的粘连。但大多数患者经显微手术治疗可取得良好的效果。     

61例大型听神经瘤显微手术治疗体会

作者自1994年1月至1998年12月经显微手术切除大型听神经瘤61例(直径≥3cm)，现将手术治疗的经验总结如下，并对肿瘤切除和面、听神经保护等关键技术要点进行讨论。     

大型、巨大型听神经瘤的显微手术治疗

目的 探讨显微神经外科技术在大型听神经瘤切除术中的应用。方法 通过对285例大型、巨大型听神经瘤显微外科手术治疗的病例进行统计分析。结果 应用显微外科技术将肿瘤全切除262例,次全切除23例。面神经保留率达69.5％,听神经保留率32％。结论 对大型、巨型的听神经瘤选择不同的手术入路,应用显微外科技术,可提高肿瘤全切除率,有效地保护颅神经的功能。     

专家点评

<正>听神经瘤是最常见的颅内良性肿瘤之一,直径大于3 cm的听神经瘤定义为大型听神经瘤;其治疗方式应积极选择显微手术治疗~([1-2])。大型听神经瘤推挤压迫脑干,瘤周的血管、神经解剖变异大;手术如何完美实现肿瘤切除和面神经功能保护对神经外科医师仍充满挑战。本文章作者报道了一组大型听神经瘤病例,肿瘤全切率87. 5%,术中面神经解剖保留率100%,术     

听神经瘤手术治疗的临床体会

目的 总结104例听神经瘤手术切除的体会，以提高此类手术的治疗效果。方法 经CT或MRI扫描检查确诊，应用显微外科技术，经枕下-乙状窦后入路行肿瘤切除术。结果 肿瘤全切89例（85．58％），次全切和大部切除15例（14．42％）；术后死亡2例（1．92％）。术中面神经解剖保留89例（85．58％），听神经解剖保留25例（24．04％），术后7例（6．73％）听力保存或有所改善。结论 肿瘤大小与肿瘤全切率及面、听神经保留率密切相关。合适的体位，正确的切除方法及较强的功能保护观念，是提高听神经瘤手术疗效的关键。     

听神经瘤的显微手术治疗及预后分析

正听神经瘤是桥小脑角区最常见的肿瘤,发病率占颅内肿瘤的8%~10%,约占该区肿瘤的80%~95%~([1]),手术切除可获痊愈。由于其位置深在,周围有脑干、后组颅神经、椎动脉系统等重要结构,手术既要切除肿瘤,又要尽可能的保护面、听神经及周围重要结构,并非易事。我院自2007年1月至2015年4月采用经枕下乙状窦后入路显微手术切除听神经瘤64例,疗效满意,总结如下。     

桥小脑角肿瘤术中面、听神经监护

目的研究术中监护下桥小脑角肿瘤显微镜下切除的临床疗效。方法在41例桥小脑角肿瘤切除手术中,均进行脑干听觉诱发电位和面神经肌电图监护。结果肿瘤全切除者33例,次全切除者7例,大部切除者1例。41例患者均达到了面神经解剖保留,27例(65.9%,27/41)患者保留听力,其中14例为听神经瘤,占听神经瘤的56.0%(14/25)。结论术中脑干听觉诱发电位和面神经肌电图监护对于桥小脑角肿瘤切除术有重要的临床价值。     

Epithelioid schwannomas of the acoustic nerve

Epithelioid schwannomas occur predominantly in relation to peripheral nerves and are associated with histological and clinical malignancy. However, a variant of the epithelioid schwannoma involving cranial nerves is extremely rare. In this study we report three cases of epithelioid schwannomas originating from the acoustic nerves and located in the cerebello-pontine angles. In the first case, the tumor was histopathologically entirely solid and demonstrated biphasic pattern with both spindle-shaped cells and a population of round or polygonal epithelioid cells. The second one consisted of the smaller part exhibiting typical Antoni B and A tissue and large areas containing clusters and bundles of epithelioid cells. Purely epithelioid schwannoma composed predominantly of cords or nests of round and polygonal epithelioid cells were observed in the third case. All schwannomas revealed marked polymorphism and nuclear hyperchromasia. Immunohistochemical studies showed a diffuse, strong positivity for S-100 protein in the cytoplasm of the spindle and epithelioid tumor cells. These two populations of cells were positively stained for vimentin, but were negative for EMA, cytokeratin and HMB45. Patchy GFAP-immunoreactivity was also noticed at the peripheral parts of the tumors. The authors discuss differential diagnosis of this unusual variant of schwannoma in relation to malignant transformation of the epithelioid component.     

Vagal schwannoma of the cerebello-medullary cistern presenting with hoarseness and intractable tinnitus: a rare case of intra-operative bradycardia and cardiac asystole

Schwannomas arising from the lower cranial nerves (IX-XI) are rare, constituting only 3% of all intracranial schwannomas unassociated with neurofibromatosis. A great majority of these tumours present as jugular foramen lesions and less commonly they occur along the extracranial course of these nerves. An intracisternal location is extremely rare. We report a case of vagal schwannoma purely in the cerebello-medullary cistern causing distortion of the medulla oblongata. Total microsurgical excision of this tumor, arising from one of the rootlets of the vagus nerve, was achieved with preservation of the 9th, 10th and 11th cranial nerves.The intraoperative course was complicated by two episodes of complete cardiac asystole, each lasting for 4(s), and six episodes of severe bradycardia. The patient was relieved of his intractable tinnitus but continued to have a hoarse voice due to an ipsilateral partial vocal cord palsy.     

Unusual case of multiple cellular and malignant schwannomas of the cranial and spinal nerves

Schwannomas from cranial nerves and spinal roots are most often benign, malignant schwannomas being uncommon in this location. This report describes a unique case of multiple cellular and malignant schwannomas of the cranial and spinal nerves in a patient with features of neurofibromatosis 2. The tumors were arising from left optic, bilateral oculomotor, trochlear, abducent and vestibular nerves, the left facial and the spinal lumbar nerve roots. The tumor arising from the right trochlear nerve was seen excavating into the hippocampus and the left vestibular nerve into the medulla. In addition, the patient had nodular schwannomas adherent to the inferior surface of the optic chiasm and the cerebellum away from the cranial nerves. Hyperplastic schwannosis was noted in perivascular spaces of thalamus, cerebellum and hippocampus on both sides away from the main lesions. The immunohistochemical and ultrastructural profiles of the tumors suggest that neurofibromas and schwannomas are probably not distinct tumors but lie within a spectrum that differs histologically depending on the predominant cell type.     

神经鞘瘤中NF2基因外显子2突变及意义

目的 :研究神经鞘瘤中 型多发神经纤维瘤病基因 (NF2 )外显子 2的突变及其意义。方法 :用 PCR- SS-CP、 DNA测序检测 36例神经鞘瘤 (听神经瘤 16例 ,其它 2 0例 )中 NF2基因外显子 2的突变。结果 :我们共发现 4例突变 ,均为听神经瘤 ,其中移码突变 2例、反义突变 2例。结论 :NF2基因外显子 2的突变可能是听神经瘤发生中的关键因素。     

X-刀治疗听神经瘤后脑神经损害的观察

目的:探讨放射外科治疗听神经瘤的常用剂量对相邻脑神经的损害。方法:中、小型听神经瘤12例,采用等中心直线加速器放射外科治疗,分区测量听神经、面神经、三叉神经和后组脑神经的最高受累剂量,随访6～21个月。结果:16.1Gy照射听神经造成听力减退发生率为71.4％,有效听力保留率为72.7％;15.4Gy照射三叉神经造成三叉神经损害发生率为42.9％;15.7Gy的照射剂量仅造成1例面神经损害加重;14.2Gy的剂量未造成后组脑神经损害。结论:放射外科治疗中,小型听神经瘤采用14～20Gy的周边剂量是安全的;感觉神经的放射耐受性较运动神经为低。     

听神经瘤听力保留的显微解剖学研究

目的 为经单侧枕下乙状窦后入路,切除听神经瘤保护听力提供解剖学参数。方法 20例成人汉族尸头湿标本进行解剖学研究。结果 桥脑小脑角区的显微解剖结构复杂,各重要神经、血管之间组织层次分明。结论 研究桥脑小脑角区的显微解剖,有助于听神经瘤的切除,保护重要结构,是听神经瘤手术保留听力的解剖学基础。     

大型听神经瘤的显微手术入路探讨

目的 探讨切除大型听神经瘤的手术入路、操作技巧及治疗效果。方法对55例大型听神经瘤患者采用显微手术治疗，其中经枕下-乙状窦后入路手术治疗45例，经岩骨乙状窦前入路手术治疗10例。结果肿瘤全切49例，次全切除6例。面神经解剖保留率为85．45％（47155）。术后随访1年，面神经解剖保留者中有35例面神经功能获得满意恢复。经岩骨乙状窦前入路并发症多见。结论经枕下-乙状窦后入路显微手术切除大型听神经瘤，可获得满意的面神经解剖学保留与功能保护，能明显降低并发症的发生率。     

Fractionated radiation therapy for vestibular schwannoma

Vestibular schwannomas are the most common tumors of the cerebellopontine angle. Multiple management paradigms exist for patients with these benign tumors, including observation, microsurgery, stereotactic radiosurgery, and fractionated radiation therapy, or some combination of these. While the proper course of management is controversial, the goals of therapy are to achieve excellent local tumor control and optimize functional outcomes with as little treatment-related morbidity as possible. Decision-making is tailored to patient-specific factors such as tumor size, clinical presentation, patient age, and goals of hearing preservation. We review the literature in order to summarize the application of fractionated radiation therapy to this tumor entity, where it is used as a primary treatment or, more commonly, as an adjunct therapy. We also provide an overview of the use of fractionated radiation therapy for the preservation of hearing and facial function, and dosing and other technical considerations, in light of the indolent natural history of vestibular schwannomas. We also discuss potential risks associated with this treatment modality, including its effects on temporal bone structures and cranial nerves among other possible complications. Lastly, we outline future directions in this rapidly evolving segment of vestibular schwannoma therapy, which has benefited from the advent of intensity-modulated radiation therapy coupled with stereotactic localization.     

囊性听神经瘤显微手术治疗:36例报告

目的探讨经枕下乙状窦后入路开颅囊性听神经鞘瘤的肿瘤全切率,面、听神经保留率。方法 2002年8月至2009年7月对36例经枕下乙状窦后入路开颅囊性听神经鞘瘤手术进行系统回顾,同时对33例患者以信函或复诊两种方式进行了术后随访,并对结果进行统计学分析。结果囊性听神经鞘瘤手术全切率为64%(23例),次全切除率为25%(9例),部分切除率为11%(4例),面神经解剖保留27例(75%),功能保留5例,听神经解剖保留2例(5.6%),功能保留2例,较实质性肿瘤全切率及面、听神经保留率明显降低。结论应把囊性听神经鞘瘤作为一种特殊类型来处理。