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

The enlarged translabyrinthine removal of large acoustic neuromas: 18 cases report

OBJECTIVE: To investigate the surgical methods and results of enlarged translabyrinthine approach in the removal of large acoustic neuromas. METHOD: A large mastoidectomy involved complete exposure of sigmoid sinus, the dura behind the sinus for at least 1 cm, the superior petrosal sinus and the middle fossa dura. The jugular bulb was exposed and pressed downwards if necessary. The internal auditory meatus was skeletonized and uncovered for at least 270 degrees. The debulking of the tumor began inside the anterior and inferior poles in order to find the brainstem and the facial nerve root as early as possible, then the dissection of the nerve was performed medially to laterally. Intraoperative facial nerve monitoring and postoperative CT and MRI were performed in all cases. RESULT: Total removal was achieved in all 18 patients with tumors larger than 3 cm (mean size: 4.2 cm). There were no death as well as other complications such as intracranial infection and persistent cerebrospinal fluid leakage. There were no obvious cerebral sequela. The facial nerve was preserved both anatomically and functionally in 14 cases, with Grade I or II in 8 cases, Grade III or IV in 6 cases. Nerve interruption occurred in 4 cases who all had severe facial paralysis or nerve interruption before operation. 16 patients returned to work within 1-3 months. CONCLUSION: Total removal of large acoustic neuroma could be accomplished via the translabyrinthine approach, with good result of facial nerve function and minimum incidence of morbidity.