大型听神经瘤的显微手术治疗

目的 探讨显微手术切除大型听神经瘤的入路和方法。方法 经枕下入路显微手术切除大型听神经瘤226例，其中锁孔手术93例。结果 肿瘤全切除193例，次全切除33例。术后死亡1例。术后出现肿瘤部位血肿4例。术中面神经解剖保留205例。177例出院后随访2月~13年，面神经House-Brachmann分级Ⅰ~Ⅲ级143例，Ⅲ级以上34例。结论 枕下入路是显微手术切除大型听神经瘤的有效入路，并能较好地保留面神经功能；强调术中监测，仔细、耐心操作以便保留面神经的功能；当肿瘤与面神经或脑干粘连紧时勿强求肿瘤全切；锁孔手术完全可以达到切除大型听神经瘤要求，损伤小。

Microsurgery through suboccipital approach for large acoustic neuromas

Objective To explore the clinical effect of microsurgery through suboccipital approach on large acoustic neuromas. Methods The clinical data of 226 patients with large acoustic neuromas who underwent microsurgery through suboccipital approach from January, 2000 to June, 2014 were analyzed retrospectively. Ninety-three patients received keyhole surgery. Results Total resection of the tumors was achieved in 193 patients and subtotal in 33 due to severe adhesion to the facial nerve or the brain stem. Anatomic preservation of facial nerves was achieved in 205 patients. Of 70 patients with severe hearing loss before the operation, 34 still had hearing after the operation and 36 not. Hematomas within the tumorous cavities occurred in 4 patients and one patient died after the operation. The following-up of 177 patients from 2 months to 13 years showed that 143 patients had House-Broukmam grades Ⅰ~Ⅲ facial nerve function and 34 grades Ⅳ~Ⅴ. Conclusions The microsurgery through suboccipital approach is a good method to treat acoustic neuromas. For preservation of facial nerve function, the facial nerve monitoring is recommended during microsurgery for large acoustic neuromas. It is not necessary to totally resect the tumor which severely adheres to the facial nerve or the brain stem. The large acoustic neuromas may be totally resected by the keyhole surgery, which produces a little operation side injury.