显微手术切除大型听神经瘤术后听力的保留

背景与目的：大型听神经瘤在全切除肿瘤的同时保留患者的面、听神经功能是神经外科医生的难题,本研究探讨在面、听神经功能监护下,显微手术切除大型听神经瘤术后听力保留的可能性。方法：对2002年1月至2008年4月湘雅医院神经外科同一术者（袁贤瑞教授）在面肌肌电图和耳蜗神经监测下,经乙状窦后入路显微手术切除的127例大型听神经瘤手术中有完整听力随访资料的41例病例进行回顾性研究。听功能采用北京市耳鼻咽喉科研究所研制的普通话言语测试材料（mandarin speech test materials,MSTMs）句表进行言语识别率测试和纯音听阈测定（PTA）,并使用New Hannover Classification听力分级法进行术后听力分级。结果：127例患者中,术中10例获得明确的听神经解剖学保留,其余117例术中未能找到确切的听神经。对随访到的41例听神经瘤患者进行术后听功能评价,听力保留率为26.8%。结论：对于有相当经验的神经外科医生来说,在面、听神经监护下,经乙状窦后-内听道入路显微手术全切除大型听神经瘤的同时可以保留部分患者的听神经功能。

Hearing Preservation in Large Acoustic Neuromas

BACKGROUND ＆ OBJECTIVE：It is a problem to preserve hearing function inpatients after large acoustic neuromas fully resection. This study investigated the possibility of hearing preservation in patients who underwent microsurgical resection for large acoustic neuromas. METHODS： Clinical data of 127 cases with acoustic neuromas in the Neurosurgical Department at Xiangya hospital from January 2002 to April 2008 were retrospectively reviewed. All 127 cases were operated by a senior neurosurgeon via rstrosigmoid approach. Of 127 cases, 41 cases had complete follow-up of hearing function, which was evaluated using New Hannover Classification with speech discrimination score （SDS） and pure tone audiometry （PTA）. RESULTS： Among 127 cases, acoustic nerve was anatomically preserved in 10 cases while acoustic nerves were hard to identify in the rest of 117 cases. According to the New Hannover Classification, hearing was preserved postoperatively （H1-H3） in 11 of 41 patients （26.8%）. CONCLUSION： Hearing preservation in large acoustic neuroma resection is still a challenge for neurosurgeons. All attempts should be practiced to preserve hearing function. Hearing preservation can be achieved in some of patients for an experienced neurosurgeon.