大型听神经瘤显微外科治疗及其相关解剖的探讨

目的探讨大型听神经瘤(最大径≥4cm)的相关解剖、手术技巧及其疗效。方法回顾性分析62例大型听神经患者的临床资料,包括手术治疗、术中所见及手术疗效等。结果术中见面神经位于肿瘤正前方34例(54.8%),前上方11例(17.7%),前下方7例(11.3%),上极5例(8.1%),下极5例(8.1%)。脑干与肿瘤无粘连14例(22.6%),轻微粘连42例(66.7%),严重粘连6例(9.7%)。62例均主要由小脑前下动脉供血,该动脉位于肿瘤上方55例(88.7%),下方7例(11.3%)。小脑后下动脉参与供血17例(27.4%),小脑上动脉参与供血12例(19.4%),基底动脉参与供血3例(4.8%),硬脑膜动脉参与供血5例(8.1%)。肿瘤全切58例(93.5%),次全切4例(6.5%);面神经解剖保留55例(88.7%),未能保留7例(12.5%)。随访1～4.5年,面神经功能状态按House-Brackman分级,Ⅰ、Ⅱ级35例(56.5%),Ⅲ、Ⅳ级19例(30.6%),Ⅴ、Ⅵ级8例(12.9%)。结论研究听神经瘤的相关解剖和掌握正确显微手术方法,有助于提高大型听神经瘤手术治疗效果。

Microsurgery for large acoustic neuromas and anatomy related to them

Objective To explore the anatomy related to the large acoustic nearomas and microsurgical technique to treat them. Methods The clinical data of 62 patients with large acoustic neuromas（the diameter ≥4 cm） ,who underwent microsurgery from February,2005 to February,2009,were analyzed retrospectively,including the curative effects,anatomy related to the neuromas and so on. Results The facial nerves were anterior to the tumors in 34 cases（54.8%） ,anterior and superior in 11 cases（17.7%） ,anterior and inferior 7 cases（11.3%） ,superior in 5 cases（8.1%） and inferior in 5 cases（8.1%） . There was no adhesion between the brainstem and tumor in 14 cases（22.6%） ,light adhesion in 42 cases（67.7%） ,and severe adhesion in 6 cases（9.7%） . The blood supplied to the tumors mainly came from the branches of anterior inferior cerebellar arteries（AICA） in 62 cases,but it partly came from posterior inferior cerebellar arteries in 17 cases（27.4%） ,superior cerebellar arteries in 12 cases（ 19.4%） ,basilar arteries in 3 cases（4.8%） ,and dura mater arteries in 5 cases（8.1%） . Total removal of the tumors was achived in 58 cases（93.5%） and subtotal in 4 cases（6.5%） . The facial nerves were preserved anatomically in 55 cases（88.7%） ,and failed to retain in 7 cases（12.5%） . The following up from 1 to 4 years showed that the function of the facial nerves belonged in House-Brackman grade Ⅰ～Ⅱ in 35 cases（56.5%） ,grade Ⅲ～Ⅳ in 19 cases（30.6%） and grade Ⅴ～Ⅵ in 8 cases（12.9%） . Conclusions Understanding the anatomy related to the tumors and the grasp of the proper microsurgical technique are helpful to the surgical treatment of the large acoustic neuromas. The key points of microsurgery for the large acoustic neuromas includes the protection of the brain stem,cerebellum and cranial nerves and so on.