枕下乙状窦后入路锁孔手术切除听神经瘤

目的 探讨枕下乙状窦后入路锁孔手术切除听神经瘤的方法及效果。方法 回顾性分析2016年1月至2018年6月经枕下乙状窦后入路锁孔手术治疗的116例听神经瘤的临床资料，根据术前增强MRI分为中小型听神经瘤组（最大径≤3 cm；83例）和大型听神经瘤组（最大径>3 cm；33例）。结果 中小型听神经瘤组肿瘤全切除率为97.6%（81/83），面神经解剖保留80例（96.4%）。术后1周面神经功能良好（H-B分级Ⅰ~Ⅱ级）59例（71.1%）。大型听神经瘤组肿瘤全切除率87.9%（29/33），面神经解剖保留28例（84.8%），术后1周面神经功能良好18例（54.5%）。结论 对于中小型听神经瘤，采用枕下乙状窦后入路锁孔手术可实现肿瘤完全切除和良好的面神经功能保护。对于大型听神经瘤，在良好体位、充分释放脑脊液、电生理监测等辅助下，采用乙状窦后入路锁孔手术也可实现肿瘤安全满意切除和面神经功能保护。

Retrospective analysis of resecting acoustic neuromas by keyhole surgery via suboccipital retrosigmoid approach

Objective To summarize the clinical experience in resecting the acoustic neuromas by keyhole surgery via suboccipital retrosigmoid approach. Methods The clinical data of 116 patients with acoustic neuroma, who underwent the keyhole surgery via suboccipital retrosigmoid approach from January, 2016 to June, 2018, were analyzed retrospectively. Results The gross-total resection rate of the neuromas was 97.6% (81/83), the rate of anatomical preservation of the facial nerve was 96.4% (80/83), and the good rate of facial nerve function (H-B grade Ⅰ~Ⅱ) was 71.1% (59/83) after the surgery in 83 patients with the small and medium acoustic neuromas. The gross-total resection rate of the tumors was 87.9% (29/33), The rate of anatomical preservation of the facial nerve was 84.8% (28/33), and the good rate of facial nerve function was 54.5% (18/29) after the surgery in 33 patients with large acoustic neuromas. Conclusions The acoustic neuromas can be totally resected by the keyhole surgery via the suboccipital retrosigmoid approach and there is good facial nerve function after the surgery in the patients with small and medium acoustic neuromas. The safe and total resection of the tumors and good neuroprotection of the facial nerve can be reached by the keyhole surgery via the suboccipital retrosigmoid approach with the aid of the good posture, sufficient release of cerebrospinal fluid and electrophysiological monitoring in the patients with large acoustic neuromas.