听神经瘤的耳神经外科治疗——附9例报告

报道9例听神经瘤的耳神经外科治疗。讨论了手术依据、术式选择、手术并发症和有关注意事项,提出CT/air显著增强了CT扫描仪诊断听神经瘤的功能,促进了早期诊断,有利于耳神经外科开展听神经瘤手术。认为神经外科与耳神经外科在听神经瘤的诊断和治疗上各有特点,均应发展,互为补充,以利于听神经瘤外科治疗在我们国家更广泛地开展。     

听神经瘤误诊57例分析

听神经瘤是耳神经外科常见疾病,占颅内肿瘤的5％～10％,占桥小脑肿瘤的80％以上。据统计,欧美国家报道听神经瘤年发病率为0．5／10万～2／10万,且近年有上升趋势。1998—05／2007—12在承德市中心医院耳科及神经外科收集听神经瘤误诊的患者57例,现将误诊原因分析如下。1临床资料1．1一般资料本组男26例,女31例,年龄34～69（平均49．31）岁。初诊就诊主要以听力下降为主29例,耳鸣耳闷17例,旋转性眩晕6例,眩晕伴面部麻木2例,     

阻碍慢性青光眼病人早期就诊的原因调查

[目的]探讨阻碍慢性青光眼病人早期就诊的原因。[方法]采用深入访谈法对127例病人进行逐步深入主题的访谈。[结果]病人的认知水平是阻碍慢性青光眼病人早期就诊的决定性因素,而病人的健康状况、医疗负担、工作性质和就诊的方便程度为非决定性因素。[结论]眼科医护人员应大力宣传眼科医学知识,完善社会普查保健系统。     

阻碍慢性青光眼病人早期就诊的原因调查

[目的]探讨阻碍慢性青光眼病人早期就诊的原因。[方法]采用深入访谈法对127例病人进行逐步深入主题的访谈。[结果]病人的认知水平是阻碍慢性青光眼病人早期就诊的决定性因素，而病人的健康状况、医疗负担、工作性质和就诊的方便程度为非决定性因素。[结论]眼科医护人员应大力宣传眼科医学知识，完善社会普查保健系统。     

听神经瘤术后面瘫患者的生活质量调查及相关因素分析

目的评估听神经瘤术后面瘫患者的生活质量,分析影响生活质量的相关因素,探讨护理对策。方法采用问卷形式对63例听神经瘤术后面瘫患者生活质量进行调查分析。结果患者的生活质量不同程度下降,包括生理、心理、社会职能改变。结论听神经瘤术后面瘫患者的生活质量下降,导致生活质量下降的主要因素是面瘫引起面部功能减退、外貌的改变,影响了患者在心理以及由此引发的社会职能观念改变,且对家庭、社会情感需求增高。因此对听神经瘤术后患者除常规护理外,应重视面瘫对生活质量的影响,加强护理干预,以提高患者的生活质量。     

听神经瘤51例围手术期的护理

目的探讨护理干预听神经瘤患者围手术期的临床护理效果。方法对同济医院神经外科收治的51例听神经瘤患者的临床资料进行回顾性分析和总结,加强患者术前心理护理和指导,术后严密观察病情变化,采取相应的护理措施预防并发症的发生。结果 51例中,40例治疗后痊愈出院,10例好转自动出院,1例死亡。结论做好听神经瘤围手术期护理对于提高听神经瘤的手术疗效,提高患者的生存质量,改善其预后起着重要意义。     

对听神经瘤的面神经分型及其手术方式探讨

目的 研究听神经瘤手术对面神经的损伤，并探讨其手术方式。方法选取2003年1月至2008年1月在本院就诊的听神经瘤患者65例，年龄35-48岁。按照听神经瘤术中对面神经的分型来进行手术。结果65例中64例手术结果良好，1例面神经受到损伤。结论通过术中听神经瘤对面神经的分型来进行手术，有助于临床治疗。     

经迷路入路听神经瘤切除术的围手术期护理

目的 探讨经迷路入路听神经瘤切除手术围手术期的护理要点.方法 对2009年1-12月由耳科经迷路入路联合神经外科完成听神经瘤切除术的36例患者,进行详细的术前评估,重点观察术中手术体位安全、现存及潜在的皮肤损伤危险及防范措施.结果 36例经迷路切除的听神经瘤手术,全部保留面神经,无一例面瘫发生,无一例因体位变化和长时间受压而导致的皮肤损伤.结论 手术室全期护理贯穿在手术前、中、后期的全过程中.通过手术术式的不断完善,护理细节的不断总结,以使每一例患者都能平稳度过围手术期.     

阻碍糖尿病视网膜病变患者早期就诊的原因调查

目的探讨阻碍糖尿病视网膜病变（DR）患者早期就诊的原因。方法采用深入访谈法对40例DR患者进行逐步深入主题的访谈。结果影响DR患者早期就诊的主要因素是患者的认知水平，对危害认识不足，其次是健康状况、医疗负担、家庭支持系统以及畏惧程度。结论对DR患者健康教育的重点是眼病的防治教育，应大力宣传眼病医学知识，完善社会对糖尿病（DM）特殊群体普查保健系统。     

显微手术切除大型听神经瘤的护理配合

总结显微手术切除大型听神经瘤的术中配合经验。本组显微手术治疗大型听神经瘤患者70例，其中肿瘤全切除59例，次全切除11例。提出手术室配置神经外科专职护士，帮助患者准确摆放手术体位，熟悉手术方法步骤，熟练掌握专科特殊器械的使用，术中密切配合操作，进行神经电生理监测，熟悉神经外科医生的手术需求，从而提高手术效果。     

听神经瘤术后患者家属心理状态的质性研究

目的了解听神经瘤术后患者家属的心理状态,为提高家属的生活质量提供依据。方法采用深度访谈法收集9例神经功能损害中重度的听神经瘤患者家属的个案资料,并用现象学分析法进行分析。结果 9例家属在照顾患者时出现了以下的心理状态:焦虑,怀疑与担心,压力与支持,情绪消极。结论听神经瘤术后患者家属需要真切的人文关怀、情感和社会保障制度的支持,以减轻其出院后的照顾压力,提高家属及患者的生活质量。     

神经内窥镜辅助显微手术治疗听神经瘤

目的　探索神经内窥镜辅助显微神经手术经乙状窦后入路治疗听神经鞘瘤的实用性及效果。方法　对 10例听神经瘤进行了神经内窥镜辅助显微手术切除 ,术中用 0°和 3 0°神经内窥镜观察内听道口 ,如果发现有肿瘤残留 ,在神经内窥镜辅助下行残留肿瘤切除。结果　 10例听神经鞘瘤均全切除并面神经保留 ,术后面神经功能Ⅰ级 6例 ,Ⅱ、Ⅲ级各 2例 ,听力保留 1例 ,无脑脊液漏等并发症。结论　经乙状窦后入路神经内窥镜辅助显微手术治疗听神经鞘瘤 ,有利于提高手术疗效 ,降低手术危险性     

听神经瘤术后继发并发症护理干预的效果评价

目的 探讨听神经瘤术后颅神经损伤所致继发并发症的预防方法.方法 选择2004年8月～2008年6月住院行听神经瘤切除术的80例患者,随机分为研究组(40例)和对照组(40例),对照组采用术后常规护理,研究组采取早发现、早护理、早预防的系统并发症护理方法,比较两组术后继发并发症发生率的差异.结果 研究组口腔感染、口腔烫伤、眼部感染、肺部感染的发生率均明显低于对照组(P<0.05).结论 听神经瘤术后采取系统并发症护理干预,能有效地降低继发并发症的发生率.     

Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia

Objective.— To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Background.— Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Methods.— Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow‐up was in clinic and via telephone interview. Results.— Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow‐up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. Conclusion.— In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries.     

An educational program to improve quality of life for individuals with acoustic neuroma.

Nursing management of the patient with an acoustic neuroma begins during the preoperative period and continues into the rehabilitative phase following hospital discharge. This article describes the process of developing and implementing an acoustic neuroma educational program. Program content was determined by a survey which identified the type of information acoustic neuroma patients wanted before and after surgery. The survey also described the problems patients encountered once home. Included in the program is a preoperative informational video, a discharge booklet, a multidisciplinary rehabilitation group for outpatients and educational sessions for nurses from the hospital and community.     

大型听神经瘤的显微手术治疗

目的总结大型听神经瘤的显微手术经验。方法回顾性分析经枕下一乙状窦后人路21例大型听神经瘤的显微手术。结果本组病例全切或近全切18例（85．7％）;大部分切除3例（14．3％）;面神经解剖保留16例（76．2％）;死亡1例（4．8％）。结论采用经枕下一乙状窦后人路显微久科技术切除大型听神经瘤是一种安全、有效的方法。     

Acoustic neuroma: postoperative vertigo and the mechanisms of compensation.

Ninety-five percent of patients with acoustic neuroma experience some degree of vertigo preoperatively, postoperatively or both. Postoperative vertigo is often a debilitating condition that results when the eighth cranial nerve is severed during surgery to resect a tumor growing around the vestibular portion of this nerve. Thus, surgery for acoustic neuroma affects the membranous labyrinth, which is the functional part of the vestibular apparatus and is primarily concerned with equilibrium. Compensation for impaired equilibrium may be by biofeedback in the vestibular pathways, visual control, exercise or drug therapy. Nurses can significantly influence the recovery of acoustic neuroma patients by encouraging and reinforcing exercise and other mechanisms of vestibular compensation.     

Headache after resection of acoustic neuroma

Long-lasting severe headaches are reported to occur in up to 83% of patients who have undergone resection of acoustic neuroma, especially through a suboccipital approach. These headaches, however, are not well defined. The objective of this study was to assess the frequency and character of new-onset headaches after resection of acoustic neuroma by a suboccipital approach with cranioplasty. Review of the medical record was followed by a telephone interview with 48 patients (67% female; mean age, 52 years) who had undergone resection of an acoustic neuroma through a suboccipital craniotomy during the 2 years before the study. Of the 48 patients, 58% had post-operative head pain that lasted more than 7 days and could be categorized into two types. A moderate to severe, short-term head pain with gradual resolution occurred in 35% of the patients, and a mild, unremitting pain was reported by 23%. Both types of pain had a dull ache or pressure quality and were adjacent to or confined to the incisional area. Overall, 77% of the patients were pain-free within 4 months after operation. Age, sex, tumor size, or preoperative history of headache did not influence development of the postoperative pain.
We found that new-onset headache after resection of acoustic neuroma by a suboccipital approach with cranioplasty is much less common than previously reported and is best described as mild incisional pain rather than a severe headache. The literature regarding headaches after different surgica1 approaches for acoustic neuroma resection is reviewed, and possible explanations for development of the pain are discussed.     

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。