听神经瘤切除术中内听道内肿瘤的个体化处理

目的 探讨听神经瘤的内听道部分的处理方法及其效果。方法 回顾性分析2015年1月至2017年12月采用枕下乙状窦后入路手术切除的37例听神经瘤的临床资料。依照内听道病理形态及病人综合情况，19例采取磨除部分内听道后壁法，16例采用刮除法，2例内听道内肿瘤未予处理。结果 全部病例面神经均解剖保留，术后1周面神经功能I~Ⅱ级34例，Ⅲ~Ⅳ级2例，Ⅴ级1例；术后3个月面神经功能Ⅰ~Ⅱ级35例（94.6%），Ⅲ级1例（2.7%），Ⅳ级1例（2.7%）。肿瘤全切除33例，次全切除4例。术后发生瘤腔再出血1例，脑脊液耳漏合并颅内感染1例。无死亡病例。术后随访1~3年，1例残余肿瘤明显增大，行伽玛刀治疗后得到控制；其余病例未见明显残余肿瘤增大或复发。结论 枕下乙状窦后入路手术切除听神经瘤中，依照内听道病理形态及病人综合情况，个体化处理内听道内肿瘤安全有效。

Individualized treatment of tumors in the internal auditory canals during resection of acoustic neuromas

Objective To investigate the anatomical variation of the internal auditory canals (IACs) in the patients with the acoustic neuromas, and to introduce the individualized treatment of the tumors in IACs according to different pathological morphology of IACs. Methods A retrospective analysis of the clinical data of 37 patients with acoustic neuromas, who underwent surgery via suboccipital retrosigmoid approach in our hospital from January, 2015 to December, 2017, was made. Of 37 patients with acoustic neuromas, 20 received the resection of the tumors in IACs through rubbing out the posterior walls of the IACs, 15 underwent scraping off the tumors in IACs, and 2 did not receive the resection of the tumors in the IACs according to the pathological morphology of IACs and the patients’ comprehensive condition. All the patients were followed up from 1 to 3 years. Results The facial nerves were anatomically preserved in all the patients. Of 37 patients, 33 received the total resection o the tumors and 4 subtotal. There were grade Ⅰ~Ⅱ facial nerve function in 34 patients, grade Ⅲ~Ⅳ in 2 and grade Ⅴ in 1 one week after the operation. The postoperative complications included the intracranial hemorrhage in 1 patient and cerebrospinal fluid otorrhea combined with intracranial infection in 1. No patients died from the surgery. The γ-knife treatment were performed in 1 patient in whom the residual tumors become large 2 years after the operation. Conclusions The individualized treatment of the tumors in ICAs during the surgery via the suboccipital retrosigmoid approach for the removal of acoustic neuromas, is safe and effective according to the pathological morphology of ICAs and the patients’ comprehensive conditions and it is worth clinical spread.