老年患者大型听神经瘤的微侵袭外科治疗

目的:探讨老年人大型听神经瘤的特点、围手术期处理与微侵袭治疗策略。方法:总结2000年以来手术治疗的12例老年患者大型听神经瘤的临床特点,采用显微微创手术、加强围手术期监测与治疗,术后结合放射治疗的个体化治疗策略,总结其预后。结果:12例老年患者大型听神经瘤手术时间最短3 h,最长5.2 h,平均手术时间4.1 h。肿瘤全切3例中面神经保留2例;近全切除8例和大部切除1例中,面神经全部得以保留。术后死亡1例(肿瘤全切患者)。8例患者进行了γ刀补充治疗。11例患者得到1.5年以上随访,肿瘤控制率为100%。结论:对于老年大型听神经瘤患者,重视围手术期处理有助于降低并发症和死亡率。手术治疗应采用微创理念,强调保留术前神经功能,保证生存质量,不应以牺牲神经功能为代价强调全切。

Mini-invasive surgical management for large acoustic neuromas in the elders

Objective:To investigate the clinical characteristics of the elderly patients with large CPA(Cerebello-Pontine Angle) acoustic neuromas and to discuss the effects of individuallized mini invasive surgical strategy for the elders.Methods:Twelve patients over 60 years old with large CPA acoustic neuromas were received mini invasive surgical procedures and 8 of them(whose tumors not totally removed) also received γ-knife radiotherapy.11 patients were followed-up and the results were summarized.Results:In the 12 cases of surgical procedures,the operation time was between 3 hours to 5.2 hours,with a mean-time of 4.1 hours.Tumors were totally removed in 3 patients with the facial nerves reserved in 2 of them.In the other 9 patients whose tumors were subtotally removed,all the facial nerves reserved. 1 patient died from worsened bulboparalysis symptoms and lung infection 3 weeks after operation.Among the 9 patients whose tumors were not totally removed,8 received γ-knife radiotherapy within 1 month after operation.All the 11 patients were followed-up at 1.5 years after operation,4 tumors dissapeared,4 atrophied and 3 remained unchange.Conclusion:For elder patients with large acoustic neuromas,the pre-and post-operative treatments should be especially emphasized for reducing the rate of postoperative complications and mortality.The mini-invasive principles and the microsurgery techniques must be followed to preserve the neurologic functions and living qualities.Neurologic functions should not be sacrificed when chasing for "tumors totally resection".