大型听神经瘤的显微手术治疗及术中面神经保护

目的 探讨显微手术切除大型（肿瘤最大径>3 cm）听神经瘤的疗效及术中面神经保护的方法。方法 回顾性分析2014年1月至2018年2月手术治疗的86例大型听神经瘤的临床资料，均在电生理监测下采用枕下乙状窦后入路显微手术。结果 肿瘤全切除83例，近全切除3例。面神经保留78例（91%）；术后1周面神经功能House-Backmann分级:1级11例，2级37例，3级22例，4级16例。术后门诊随访3~30个月，术区皮下积液4例，口唇疱疹9例，无死亡病例。结论 术前多模态肿瘤-神经评估，术中实时电生理监测，精细显微手术对大型听神经瘤全切和保留面神经功能可提供保障。

Microsurgery for large acoustic neuromas and intraoperative preservation of facial nerves

Objective To investigate the curative effect of microsurgery on large acoustic neuromas (LAN) and the methods of intraoperative preservation of facial nerves. Methods The microsurgery via suboccipital retrosigmoid approach was performed under the intraoperative electrophysiological monitoring in 86 patients with LAN. The facial nerves were anatomically protected and their function were postoperatively evaluated. Results The total resection of LAN was achieved in 83 cases and subtotal in 3 cases. The anatomic reservation rate of the facial nerve was 91.0%(78/86). According to House-Backmann (HB) facial nerve function grading system, the facial nerve function was HB grade Ⅰ in 11 patients, grade Ⅱ in 37, grade Ⅲ in 22 and grade Ⅳ in 16. All the patients were followed up from 3 to 30 months. There were hydrops in 4 and oral herpes in 9 cases. No patient died during the following up. Conclusions The preoperative multimodal assesment of tumor and nerve, intraoperative electrophysiological monitoring and the skillful microsurgical technique are very helpful to the total resection of LAN and anatomic preservation of the facial nerves in the patients with LAN.