听神经瘤显微手术53例

目的探讨听神经瘤显微手术中面神经保护及内听道肿瘤的处理方法。方法53例听神经瘤患者全部采用坐位经枕下乙状窦后一内听道入路，术中行面神经及脑干诱发电位检测，术后对面神经功能评价及随访。结果53例中肿瘤全切46例（86．8％），近全切7例（13．2％）；面神经解剖保留40例（75．5％），出院时功能保留30例（H—B分级，Ⅱ级以上），随访3个月至1年，面神经功能保留36例（Ⅱ级以上），完全麻痹8例．术后颅内积气4例，脑积水3例，脑脊液漏2例，无感染及死亡病例。结论术中神经电生理检测及熟练的显微外科技术是听神经瘤切除及面神经保留的关键。

Clinical experience of the mierosurgery treatment of 53 patients with acoustic neuromas

Objective To investigate the preservation of facial nerves and management of IAC in operations of acoustic neuromas. Methods Fifty - three patients suffering from acoustic neuromas treated microsurgically with suboccipital retrosigmoid transmeatus approach in seat, and facial nerve function monitoring and brain stem evoked potential were also perfomed intraoperatively. The facial nerve function was evaluated and folloeed up after operation. Results Total resection of the tumor was achieved microsurgieally in 46 cases（86.8% ） and subtotal resection in 7 cases（ 13.2% ）. Anatomic preservation of facial nerve was achieved in 40 cases （ 75.5 % ） , and functional preservation of facial nerve （ H - B grading, above grade Ⅱ ） was in 30 patients at discharge. A follow - up study from 3 months to 1 years was perfomed in 48 patients. Functional preservation of facial nerve（ H -B grading,above grade Ⅱ ）was in 36 patients. After operation completely paralysis of facial nerve was in 8 patients, and air skull was in 4 patients, and hydrocephalus was in 3 patients, and leakage of cerebrospinal fluid was in 2 patients. No patient infected and died. Conclusions It is very important of perfect microneurosurgical skills and the intraoperative monitoring to achieve the goal of total resection of acoustic neuromas and the anatomic reservation of facial nerve.