听神经瘤显微手术中瘤周血管的保护与处理

目的探讨听神经瘤手术中瘤周血管保护的意义和方法。方法回顾性分析64例听神经瘤患者的临床与手术资料,全部病例均采用枕下乙状窦后入路,显微镜下切除肿瘤。结果听神经瘤64例,其中肿瘤全切52例(81.25%),次全切12例(18.75%)。术中小脑上动脉、小脑后下动脉及其主要的分支完整保留58例(90.62%)。面神经未能解剖保留11例(17.19%);术后早期面瘫21例(32.81%),6个月至6年的随访期中14例无改善;术后死亡3例(4.69%)。结论手术中注意保护肿瘤周围正常的供血动脉,对于减少相关的并发症,改善预后十分重要。熟悉解剖和细致的显微操作是提高听神经瘤手术效果的关键。

Protection and Treatment of Blood Vessels Around Tumors during Microneurosurgery for Acoustic Neuromas

Objective To explore the importance and methods of the protection of superior cerebellar artery(SCA), anterior inferior cerebellar artery(AICA) and posterior inferior cerebellar artery(PICA) during the microneurosugery for the acoustic neuroma. Methods The clinical data of 64 patients with acoustic neuromas were analyzed retrospectively. All the tumors were resected by microneurosurgery through the suboccipital retrosigmoid approach. Results Of 64 patients with acoustic neuromas, 52 received the total resection of the tumors (81.25%) and 12 subtotal (18.75%). The SCA, AICA, PICA and their main branches were reserved in 58 cases(90.62%). The facial nerve was not reserved anatomically in 11 cases(17.19%). The following up from 6 months to 6 years showed that the facial palsy were not improved in 14 of 21 patients with facial palsy after the operation. Three patients died (4.69%) after the operation. Conclusions The reservation of the normal artery around the tumor is important to decreasing the complications and improving prognosis in the patient with acoustic neuroma. The familiar relative anatomy and skilful microneurosugical technique is the key to enhancing the curative effect of surgery on the acoustic neuroma.