骨骼肌束一期修复面神经缺损

目的　探讨骨骼肌作为一种非神经材料在修复面神经缺损的临床应用效果。方法对 2例面神经鞘瘤患者 ,在完成肿瘤切除后 ,切取患者颞肌 ,修剪成与缺损神经直径相当、长度相同的骨骼肌束 ,经 2 5 0W微波持续 12 0s干热变性处理后 ,行神经 肌肉端端吻合 ,一期修复面神经缺损。结果　经术后 2年随访 ,面肌功能恢复满意 ,临床电生理有明显反应 ,按House Brackmann评分标准面肌功能为Ⅰ～Ⅱ级。结论　干热变性骨骼肌修复面神经缺损具有较好效果 ,值得进一步研究。     

The use of muscle autograft or nerve allograft denatured by microwave for repair of gaps in rat facial nerve]

OBJECTIVE: Attempt to enhance recovery of rat facial nerve through different grafts. METHODS: Rats facial nerve mandible branch gap was repaired using different grafts, either muscle autograft or sural nerve allograft denatured by microwave. Axonal regeneration was studied in 10th week after insertion of the denatured muscle autografts or sural nerve allografts and compared with results found in autologous sural nerve grafts used as controls. Axonal regeneration, Schwann cell behavior and efficacy of nerve and muscle were quantified using CB-HRP retrograde trace, HE staining, Flamming staining and electromyography. RESULTS: Denatured nerve allografts and muscle autografts supported the higher rates and volumes of axonal regeneration. Nerve allografts had the higher degree of myelin sheath developing. CONCLUSION: Nerve autograft and muscle autograft denatured by microwave are convenient, source sufficient, higher efficient grafts for repairing facial nerve gap and have potential clinical use.     

微波变性自体骨骼肌和异体神经修复面神经缺损的实验研究

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骨髓间质细胞植入微波变性骨骼肌与自体神经桥接大鼠面神经缺损的比较研究

目的　探讨骨髓间质细胞（mesenchymal stem cells,MSCs）植入微波变性骨骼肌替代自体神经桥接修复大鼠面神经缺损的可行性。方法　培养异体骨髓间质细胞,大鼠面神经缺损模型制备及手术修复,动物电生理测试及再生神经轴突计数,统计学分析。结果　术后2周时细胞植入组中段可见再生轴突形成,而自体神经组再生轴突形成不明显;术后第4、8周自体神经组多项指标优于细胞植入组,8周时两组轴突计数之间有统计学意义;细胞植入组修复效果优于单纯骨骼肌组,但两组之间没有统计学意义。结论  骨髓间质细胞植入微波变性骨骼肌可以用于周围神经修复,但其修复效果尚未达到自体神经移植的修复效果。     

骨髓间质细胞植入变性骨骼肌修复面神经缺损实验研究

目的利用骨髓间质细胞植入微波变性骨骼肌桥接大鼠面神经缺损,研究骨髓间质细胞在面神经修复中的作用。方法骨髓间质细胞培养;大鼠面神经10mm缺损模型制备、手术修复及细胞移植;对大鼠移植段再生神经电生理测试并进行轴突计数。结果术后二周,细胞植入组轴突再生明显;术后八周,细胞移植组再生轴突计数、神经传导速度及动作电位振幅均高于单纯变性骨骼肌组。结论骨髓间质细胞植入可以促进面神经损伤的修复。然而,骨髓间质细胞移植的确切效果还需要进一步研究。     

肌电图监护下大型听神经瘤的显微手术及面神经保留

目的 介绍经枕下-乙状窦后入路大型听神经瘤显微手术切除及面神经保留技巧。方法对32例大型听神经瘤在面肌肌电图监护下行显微手术切除。结果所有32例病人均行肿瘤全切，面神经解剖保留率为96．88％。根据House-Brackmann面神经功能分级标准，面神经功能保留率术后6个月为Ⅱ级52．38％、Ⅲ级42．86％、Ⅳ级4．76％；术后1年为Ⅱ级66．67％、Ⅲ级28．57％、Ⅳ级4．76％。结论对大型听神经瘤，在面肌肌电图监护下通过显微手术技术，可以全切肿瘤同时保留面神经解剖的完整。     

The translabyrinthine approach for the removal of large acoustic neuromas

The results and the sequelae are reported from a series of consecutive 400 translabyrinthine removals of acoustic neuromas comprising almost all such tumors in Denmark during a 12-year period from 1976 to 1988. There were two intrameatal, 137 median-sized, 112 large and 149 advanced tumors, the latter having a diameter exceeding 40 mm. The mortality rate in the overall series was 2%. The incidence of cerebrospinal fluid leak occurred in 11%, and persisted for more than 2 weeks in 4%. Facial nerve function was completely normal in 67% of the patients, while only 5% required a nerve anastomosis.     

The translabyrinthine approach for the removal of large acoustic neuromas

Summary The results and the sequelae are reported from a series of consecutive 400 translabyrinthine removals of acoustic neuromas comprising almost all such tumors in Denmark during a 12-year period from 1976 to 1988. There were two intrameatal, 137 mediansized, 112 large and 149 advanced tumors, the latter having a diameter exceeding 40 mm. The mortality rate in the overall series was 2%. The incidence of cerebrospinal fluid leak occurred in 11%, and persisted for more than 2 weeks in 4%. Facial nerve function was completely normal in 67% of the patients, while only 5% required a nerve anastomosis.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris, 26–29 September 1988     

Suboccipital approach in the removal of acoustic neuromas

Modern expertise by neurosurgeons has made the suboccipital route the approach of choice in removal of acoustic neuromas. In addition to assisting the neurosurgeon, the role of the otolaryngologist should now be extended to provide re-education of physicians in order to achieve earlier referral and consequent early diagnosis.     

Function-saving microsurgery in suboccipital removal of large acoustic neuromas

Various successful approaches are available for acoustic neurinoma surgery, permitting total tumor removal and preservation of cranial nerve function. In smaller and medium sized tumors excellent results can be achieved with respect to facial and cochlear nerve function using the transtemporal approach. For larger tumors similar results can be achieved by the suboccipital approach. The results of 45 completely removed large acoustic neurinomas all operated upon via the suboccipito-lateral approach with microsurgical techniques and neurophysiological monitoring are presented. The average tumor size, excluding the portion within the internal auditory canal was 3 cm. Anatomical preservation of the VIIth cranial nerve was achieved in nearly all cases. Satisfactory to excellent facial nerve function was preserved in 70% of all cases. Initial hearing was preserved in 29%. However delayed postoperative hearing loss was encountered in 13%. Therefore definite hearing preservation was achieved in 16% of the cases. Intraoperative monitoring, especially of auditory evoked potentials, was very helpful in achieving these functional results.     

Translabyrinthine removal of large acoustic neuromas in young adults

OBJECTIVE: the authors reviewed the clinical manifestations and the surgical outcomes in a series of young patients who underwent removal of large acoustic neuromas via the translabyrinthine approach. METHODS: 40 young adults who underwent a translabyrinthine removal of acoustic neuromas 3 cm or greater in size were analyzed. The patient's age ranged from 17 to 30 years. The mean size of tumor was 4.25 cm. RESULTS: the primary symptoms are similar to those in adult but usually less intense. The average interval time between the primary symptom and the diagnosis was 17 months. A high percentage of preoperative normal hearing (35%) and good facial function (100%) were noted. Translabyrinthine approach was used in all cases. Total removal was realised in 39 patients (97.5%). The facial nerve was anatomically preserved in 37 patients (92.5%). Twenty-six patients (65%) had a good facial function (House-Brackmann grade I or II) immediately or at 1 month after surgery, 11 patients (28%) achieved grade III or IV. Three patients underwent an immediate nerve repair after tumor removal. All of them recovered to grade III or IV 1 year after surgery. Postoperative complications were minimal. CONCLUSIONS: young adults may have a rapid growth rate but usually have minimal symptoms even with a large acoustic neuroma. The translabyrinthine approach has been used successfully in removal of large acoustic tumors of young patients, with the good result of facial nerve preservation and long-term tumor control.     

扩大迷路进路切除大听神经瘤18例报告

目的：探讨通过扩大的迷路进路切除大听神经瘤的方法和效果。方法：充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜,暴露并下压颈静脉球,内听道周转骨质２７０℃以上切除。肿瘤切除从前下极处开始,以早期暴露脑干及脑干表面面神经,随后即从内侧向外侧解剖面神经。结果：１８例直径在３ｃｍ以上的听神经瘤（平均直径４．２ｃｍ）,均手术全切,脑组织无明显损伤。２例术后一过性脑脊液漏自愈,无颅内感染。面神经解剖及功能     

Complications of the translabyrinthine approach for the removal of acoustic neuromas.

OBJECTIVE: To report the complications that occurred during a large series of surgical procedures for the removal of acoustic neuromas using the translabyrinthine approach. DESIGN: Retrospective analysis. SETTING: Neuro-otology practice with academic affiliation. Procedures were performed at either a university medical center or a community hospital in conjunction with a neurosurgery team. PATIENTS: A total of 258 patients (142 men, 116 women; mean age, 51 years) underwent the translabyrinthine approach during a 14-year period. All patients had a histologically proven diagnosis of acoustic neuroma. RESULTS: There were no deaths. There were 3 cases (1.1%) of neurovascular compromise. There were 20 cases (7.8%) of cerebrospinal fluid leak, 16 (80%) of which presented as rhinorrhea and 4 (20%) as incisional leaks. The leaks at the incision responded to conservative management, while rhinorrhea usually required more aggressive means of closure. Four patients (1.6%) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in 4 patients (1.6%). Facial nerve function, as measured by the House-Brackmann system, was recorded in all patients at 1 year: 76% had a score of I or II; 18%, a score of III or IV; and 6%, a score of V or VI. Other complications included 3 cases of pneumonia, 1 case of severe gastric hemorrhage, and 1 case of wound infection. CONCLUSIONS: The results of this series generally agree with those of other large series and demonstrate the safety and effectiveness of the translabyrinthine approach in excising acoustic neuromas.     

并发慢性中耳乳突炎的大听神经瘤经扩大迷路进路二期手术切除

目的：探讨经扩大迷路进路摘除伴发慢性中耳乳突炎的大听神经瘤的手术方法。方法：先一期手术彻底清除鼓室乳突病灶，术毕封闭中耳乳突腔；2周后行二期手术，经一期径路进行听神经瘤切除术。结果：2例并发慢性中耳炎的大听神经瘤均得到全切，术后面神经功能正常，切口一期愈合。随访半年以上无感染发生。结论：并发慢性中耳乳突炎的大听神经瘤同样可经扩大迷路进路进行手术切除。     

Re-innervation of facial nerve territory using a composite hypoglossal nerve — muscle autograft — facial nerve bridge. An experimental model in sheep

The hypoglossal nerve has been used both entirely and in part to repair the facial nerve. Using the partial technique it may be difficult to obtain sufficient length and a free interposed graft is then required to extend the hypoglossal element. In six sheep the facial nerve was excised between its emergence from the stylomastoid foramen and its bifurcation in the parotid gland. The hypoglossal nerve was exposed and split longitudinally producing a limb which was reflected towards the distal stump of the facial nerve. This left a gap of 4-5 cm which was bridged with a freeze-thawed coaxially aligned skeletal muscle autograft. The sheep were examined at 8 months. Laser doppler blood-flow studies showed the blood-flow distal to the graft to be about 25% of that at an equivalent site on the normal side. Peak nerve conduction velocities were also reduced on the repaired side but stimulation of the proximal hypoglossal nerve was nevertheless capable of causing adequate contraction of both facial and tongue muscles. Histological comparison of the repaired facial nerves with equivalent sites on the normal side showed a reduction in mean axon and fibre diameters with normal myelin sheath thickness for the regenerated axon sizes. All of these features are to be expected in a regenerated nerve and are consistent with a good level of recovery of function.