显微手术治疗三叉神经鞘瘤

目的 总结各种类型三叉神经鞘瘤手术入路的优缺点。方法 回顾分析１９８０年４月￣１９９７年６月手术治疗的３４例三叉神经鞘瘤的临床效果。结果 肿瘤完全位于中颅窝的３例,均采用颞下入路切除,肿瘤位于后颅窝的１３例,１０例经枕下入路,２例采用颞下经小脑幕入路,１例经乙状窦前入路切除。另１８例哑铃型肿瘤中１４例采用颞下经小脑幕入路,４例采用经颞下－乙状窦前入路切除。结论 颞下入路适用中颅窝型肿瘤切除,枕下入     

三叉神经鞘瘤的外科治疗

目的 探讨三叉神经鞘瘤最佳外科手术入路。方法 回顾性分析７５例三叉神经鞘瘤的临床资料和随访结果。按时间先后分为早期组和后期组进行对比。结果 早期组（１９７８￣１９８４年）应用常规硬脑膜内入路：后期组（１９８５￣１９９５年）除颅后窝型应用枕下硬膜内入路外,均用颅底开颅硬脑膜外入路。早期和后期组肿瘤全切率分别为５８％（２０／３５）和８０％（３２／４０）（Ｐ〈０．０５）,暂时和永久颅神经障碍分别为６３％     

显微手术治疗巨大哑铃型三叉神经鞘瘤

三叉神经鞘瘤约占颅内肿瘤0.2%～1%[1]。我科1994年5月～1997年9月收治7例骑跨于中、后颅窝巨大型三叉神经鞘瘤,且效果满意临床资料一般资料:本组男4例,女3例;年龄20～54岁,平均29.5岁;病程2个月～5年,平均19个月。症状与体征:面部麻木6例,角膜反射减退或消失4例,颞肌和咀...     

颅中后窝哑铃型三叉神经鞘瘤的显微外科治疗

目的 探讨显微外科治疗颅中、后窝哑铃型三叉神经鞘瘤的手术入路与疗效。 方法 总结分析2001年6月至2009年5月显微手术治疗颅中、后窝哑铃型三叉神经鞘瘤19例的临床资料,其中采用乙状窦前入路10例,采用颞下硬脑膜外入路9例,比较两组入路显微手术的临床疗效。 结果 10例乙状窦前入路手术的全切除8例,术后出现患侧角膜溃疡2例,复视3例,术后患侧颞叶明显挫伤2例;9例颞下硬膜外入路手术的全切除8例,术后出现复视l例,没有患者出现角膜溃疡与颞叶挫裂伤。 结论 两种手术入路均可充分显露术野,能达到一期全切除肿瘤的目的,但颞下硬膜外入路手术有创伤小、术后并发症少的优点。     

听神经瘤cT诊断分析

目的提高听神经瘤的CT诊断和鉴别诊断。方法回顾分析9例听神经瘤的CT表现。结果9例听神经瘤中,单侧8例,双侧1例,单侧多见,位于桥小脑角区,具有特定的发病部位。结论CT在影像诊断与鉴别诊断上有明显的特征性表观。     

腹膜后节细胞神经瘤与神经鞘瘤的影像学鉴别

目的 对比分析腹膜后肾上腺外的节细胞神经瘤与神经鞘瘤的影像学征象,提高两种疾病的影像鉴别诊断准确率。方法 回顾性分析2018年1月至2020年12月嘉兴市中医医院和嘉兴市第一医院经病理证实腹膜后肾上腺外的节细胞神经瘤11例（节细胞神经瘤组）和神经鞘瘤17例（神经鞘瘤组）的临床资料和影像征象,对两组影像特征数据进行统计分析。结果 神经鞘瘤组平均年龄大于节细胞神经瘤组[（50.1±12.2）岁 vs （37.9±16.8）岁,P=0.047]。神经鞘瘤组比节细胞神经瘤组病灶形态更规则[76%（13/17） vs 36%（4/11）,P=0.010],肿瘤短长径比更大[（0.65±0.18） vs （0.44±0.19）,P=0.011],病灶中心更易囊变[(41%（7/17） vs 9%（1/11）,P=0.022],神经鞘瘤与椎间孔相通比例更高[（35%（6/17） vs 0,P=0.022]。神经鞘瘤组的密度[（30.88±10.67）Hu vs （22.91±8.41）Hu,P=0.033]和T1信号[非低信号59%（10/17） vs 0,P=0.004]均高于节细胞神经瘤组,增强后动脉期和静脉期的强化程度均高于节细胞神经瘤组[（14.47±7.93）Hu vs （5.45±3.05）Hu,P<0.001;（21.12±11.82）Hu vs （12.36±3.93）Hu,P=0.007]。结论 可通过肿瘤整体形态、中心囊变、与椎间孔关系、平扫及增强CT值、MRI的T1信号来提高腹膜后非肾上腺的节细胞神经瘤与神经鞘瘤的影像诊断准确率。     

囊性听神经瘤的诊断与治疗

目的 总结囊性听神经瘤的临床特点及治疗效果。方法 22例患者术前均应用CT和MRI进行诊断,应用乙状窦后入路手术切除肿瘤。术中证实,术后病理确诊囊性听神经瘤。结果 22例肿瘤全切除18例,术后面神经功能分级：Ⅱ级4例、Ⅲ级7例、Ⅳ级3例、Ⅴ级2例、Ⅵ级2例;次全切除4例,面神经功能Ⅱ级。结论 由于囊性听神经瘤的临床特点及疗效差,应把它作为一种特殊亚型来处理。     

单纯内镜经鼻入路治疗颞下窝三叉神经鞘瘤

目的 探讨单纯内镜经鼻入路切除颞下窝硬膜外三叉神经鞘瘤的可行性.方法 2004年11月至2009年7月采用单纯内镜经鼻入路对8例颞下窝硬膜外三叉神经鞘瘤(Jefferson's D型)患者实施了外科治疗.男性4例,女性4例,年龄31～62岁,平均27.6岁.其中,面部麻木6例,头痛3例,视力减退3例,听力减退3例,画部感觉障碍2例,咀嚼肌运动障碍并萎缩1例,鼻塞1例,牙痛1例,耳鸣1例,嗅觉障碍1例.术后定期随访,复查MRI.结果 8例患者均为完全切除(全切除率100%),手术时间40～120 min,术中出血300～1500 ml,平均出血量为543.8 ml.术后5例患者切除肿瘤后有鞍旁及颞下颅底骨质缺损,在3.0 cm×2.5 cm左右.术后患者头痛症状均消失,4例患者面部麻木无明显改善,2例术前有视力减退患者术后视力恢复.未见术中及术后并发症.术后随访10～65个月无复发病例.结论 内镜经鼻入路可以完全切除侵犯颞下窝硬膜外的三叉神经鞘瘤,该入路具有简便、视觉效果好、微侵袭和并发症少等特点,并能够获得良好的预后.     

哑铃状三叉神经鞘瘤的外科治疗

目的 探讨哑铃状三叉神经鞘瘤外科的最佳手术入路。方法 将外科手术的46例哑铃状三叉神经鞘瘤患者按年代分为2组。早期组（1978－1984）患者采用一系列常规硬膜下入路手术,后期组（1985－2000）应用经颅底开颅硬膜外入路手术。回顾性分析其临床资料及治疗经验。结果 早期组肿瘤全除率为42％（5／120,后期组为85％（29／34）,2组差异有显著性意义（χ^2＝8．8,P＜0．01）。2组患者暂时性颅神经障碍发生率分别为63％、47％（χ^2＝3．4,P＞0．05）;永久性颅神经障碍发生率分别为48％、15％（χ^2＝6．1,P＜0．05）。结论 经颅底开颅经硬脑外－经天幕－经硬膜下入路是切除哑铃状三叉神经鞘瘤最好的显微外科入路,不必切除岩骨尖。     

颈部神经鞘瘤77例的诊断与治疗

目的总结颈部神经鞘瘤的诊断与治疗经验。方法回顾性分析1976-2005年收治的77例颈部神经鞘瘤患者的临床资料。结果根据病史、临床表现特点、辅助检查（B超、CT）以及细针穿刺抽吸活检可作出诊断，本组确诊51例，确诊率66．2％（51／77），误诊26例，误诊率高达33．8％（26／77）。本组77例均行手术切除。术后病理诊断为良性神经鞘瘤。术后并发症有喉返神经损伤6例，Homer征4例，伸舌偏斜3例，颈侧疼痛、麻木2例，上肢放射性疼痛1例。该16例术后随访3～11个月症状均恢复。术中误切迷走神经3例，2例术后有神经功能障碍；误切交感神经1例，术后有功能障碍。2例误切迷走神经及误切1例交感神经者随访3年功能稍有恢复，以后失访。结论B超和CT，特别是细针穿刺抽吸活检有助于诊断。手术切除是有效的治疗方法。     

Unusual appearance of an acoustic neurinoma in CT scans

Summary A large cystic neurinoma of the cerebellopontine angle is reported. This case is unusual in that the clinical history, CT patterns and plain radiological findings were rather misleading for the differential preoperative diagnosis.     

大型听神经瘤的显微手术治疗

目的：报道听神经瘤经枕下－乙状窦后显微手术切除的临床经验。提高大型听神经瘤的全切除率和面、听神经的保留率。方法：回顾性分析临床39 经显微神经外科手术治疗的大型听神经瘤，对影响肿瘤全切除的因素及手术中的关键技术点进行分析。结果：肿瘤全切除34例（占87．2％），次全切5例。术中解剖保留面神经31例（79．5％），听神经解剖保留15例（38．5％），其功能保留率分别为56．4％、17．95％。结论：应用显微外科技术是提高听神经瘤手术切除率和面、听神经解剖和功能保留率的关键。术中诱发电位的应用可提高面、听神经解剖和功能保留率。     

Facial myokymia due to acoustic neurinoma

The case of a 62-year-old female patient who presented with facial myokymia is reported. The patient had a 13-year history of progressive left-sided hearing loss. In further course, involuntary, wormlike, rippling movements of the left facial muscles developed. Computed tomography revealed a tumor located in the left cerebellopontine angle. Electrophysiologic examinations confirmed the diagnosis of facial myokymia. The tumor, which evolved from the eighth cranial nerve, was totally removed microsurgically. The tumor was histologically verified to be an acoustic neurinoma. Postoperatively, the patient had a facial nerve paralysis, and the facial myokymia was no longer present. The present case provides further evidence that facial myokymia may be triggered by alterations at one of various sites along the course of the motor axons of the facial nerve.     

Preservation of cochlear nerve function in acoustic neurinoma surgery

Summary A total of 55 cases with unilateral acoustic neurinoma which were operated on by the lateral suboccipital approach was studied to elucidate factors which influence postoperative hearing acuity. We analyzed several factors: preoperative hearing level, tumour size, tumour consistency (cystic or solid), and anatomical location of the cochlear nerve.The size of the tumours ranged from 1.2 to 5.8 cm in diameter. Thirty of 55 cases (55%) preoperatively had remaining cochlear function. The smaller the size of tumour, the higher was the preoperative hearing level excepting those tumours with a diameter of 5 cm or greater, which had relatively good hearing and often contained large cysts. As to the consistency of the tumours, 41 were solid and 14 were cystic, where 19 (46%) and 11 (79%) cases had had preoperative hearing, respectively.Anatomical continuity of the cochlear nerve was maintained at surgery in 15 of 30 cases with preoperatively remaining hearing; cochelar function was preserved after surgery in 9 of the 15 cases. It was located counter-clockwise (caudally) to the facial nerve at an angle of 50 degrees on average when they were projected on the right side. The distance or interrelation between the two nerves had no bearing on postoperative hearing preservation.Postoperatively, hearing acuity was improved in 6 cases (20%) with a mean value of 5.6 dB, unchanged in 3 (10%), and deteriorated in 21 (70%) among the 30 cases with remaining preoperative-hearing. When the tumour was less than 2 cm or cystic, better hearing preservation was expected. Hearing was preserved in 4 cases of the 19 solid tumours (21%) and in 5 of the 11 cystic tumours (45%). No cases with preoperative hearing deficit greater than 60 dB showed postoperative improvement to a useful hearing level.     

Three trigeminal neurinomas of different location and extension

Three cases of trigeminal neurinoma, which vary widely in their clinical features, location, and extension of the tumor are presented. Symptoms and radiological findings are described and supported by typical radiographs. Operation was carried out in all cases and the diagnosis of a neurinoma histologically confirmed.     

枕下-乙状窦后入路显微手术切除大型听神经瘤

目的 探讨经枕下-乙状窦后入路显微手术切除大型听神经瘤的临床疗效和意义。方法 采用枕下乙状窦后入路对49例大型（≥4 cm）听神经瘤行显微手术切除,单侧枕下乳突后“S”形皮肤切口,铣刀骨瓣成形,显微镜下行肿瘤囊内逐步切除,最后分离内听道部分,锐性剥离面神经上残存肿瘤。术前及术后分别进行面神经和听神经的功能评估。结果 肿瘤全切除45例（92%）,次全切除4例（8%）,全组无死亡病例。面神经解剖保留42例（86%）,术后2周功能保留36例（73%）;听神经解剖保留7例（14%）,术后2周功能保留3例（6%）。1例手术区血肿再手术清除。37例随访0.5～5年,平均2.8年,肿瘤无复发,均参加正常工作和学习。结论 枕下乙状窦后入路显微手术是切除大型听神经瘤的较好方法,肿瘤的全切率高,死亡率和病残率低,并能有效地保留面、听神经的功能。     

Contralateral pontine hemorrhage as a complication of acoustic neurinoma surgery

The authors report the occurrence of a contralateral pontine hemorrhage after an operation for an acoustic neurinoma. A 55-year-old woman was found to have a small pontine hemorrhage opposite to the side of the tumor immediately after the operation. The cause of the hemorrhage is discussed.     

Frontotemporal epidural approach to trigeminal neurinomas

Summary From 1980 through 1993 an series of 44 patients with trigeminal neurinomas were treated. Five of them were operated on for the remainder of the tumour as they had undergone previous surgery elsewhere, 35 were operated on for the first time, and 4 were not operated on for various reasons.An epidural approach to the neurinomas originating in the branches of the Vth nerve peripheraly to the Gasserian ganglion (GG) was used. In the neurinomas originating in the GG or in the root of the Vth nerve, either an epidural-transdural approach or an epidural-transdural-transpetrous approach was used.All tumours operated on using the approach described in this article were completely removed. In 10 patients, the Vth nerve sensory deficits increased in comparison with preoperative deficits; in 9 their state remained unaltered; and in 11 the sensory function of the Vth nerve improved. In those patients who had experienced pre-operative atypical trigeminal pain, the pain disappeared after surgery.There was no additional treatment: radiosurgery, irradiation or chemotherapy. Histopathological examination did not reveal any malignant changes in the tumours in any of the patients.Based on our own experience and on the published data it is believed tht the best treatment for trigeminal neurinomas is complete microsurgical removal of the lesion.     

Trigeminal neurinoma with unusual presentation. Report of a case with trigeminal somatosensory-evoked response

A patient with trigeminal neurinoma, presenting unusual symptoms, is described. There was no trigeminal sensory or motor deficit. The only presenting symptoms were unilateral abducens nerve paresis and alternating hemiplegic episodes. The trigeminal somatosensory-evoked response was normal before surgery. After complete removal of the tumor from both the posterior and middle cranial fossae, severe trigeminal sensory deficit ensued, accompanied by impairment of the evoked response. Improvement of the trigeminal nerve function could be predicted by significant changes in a repeat trigeminal sensory-evoked response obtained 2 months after the operation.     

Basal Lateral Subtemporal Approach for Trigeminal Neurinomas: Report of an Experience with 18 Cases

Summary  Subtemporal craniotomy centred on the external ear canal was used to surgically treat 18 trigeminal neurinomas. The approach was found to be suitable to deal with either or both the middle fossa and the posterior cranial fossa components of the tumour. The basal extension of the exposure was achieved by resection of the roots of the zygomatic arch, roof of the external ear canal and superior third of the mastoid bone. The temporalis muscle was rotated anteriorly. The direction of the approach to the tumour was the shortest and perpendicular from the surface and avoided any neural or vascular exposure or manipulation. The basal exposure was horizontally wide and significantly low which reduced the operating distance, limited the extent of temporal lobe retraction and provided additional space for manipulation of instruments. The exposure was manoeuvreable with anterior, posterior and medial expansion being possible during or prior to tumour resection. The approach had the advantage of being simple and relatively quick and of its familiarity to general neurosurgeons. The experience with the approach with trigeminal neurinomas and its possible advantages over other available approaches to these lesions are analysed in this report.