颞岩部胆脂瘤对面听神经损害的特征与治疗对策

目的探讨岩部胆脂瘤发病特征、对面听神经损害特点及治疗方法。方法回顾性分析1991年7月—2005年6月间收治的17例岩部胆脂瘤的临床资料。结果 17例中16例重度耳聋及全聋,1例为中度混合性聋,15例伴有面瘫,其中11例为迷路段缺损,1例垂直段缺损,CT检查岩部均有膨胀性改变及骨性破坏,手术采用乳突迷路进路6例次,颅中窝进路8例次,乳突颅中窝联合进路3例,颞骨扩大切除术2例,行面神经全程减压4例,由内听道段与水平段面神经端端吻合5例,舌下神经-面神经吻合1例。全部病例均顺利恢复,无感染和复发。结论岩部胆脂瘤发病率低,早期症状多不明显,中晚期可有面肌抽搐、耳流脓等症状,应详细检查,颞骨CT及MRI是最佳的检查和诊断方法 ,对已确诊岩部胆脂瘤应争取早作手术,避免颅内感染和对面听神经的进一步损害,根据病变的部位及破坏程度选择适当的手术途径。

Characteristics and treating strategies of petrous apex cholesteatoma associated facial-acoustic nerve injury

Objective To explore the clinical Characteristics and treating strategies of petrous apex cholesteatoma and associated facial-acoustic nerve injury.Methods The clinical data of 17 patients with petrous apex cholesteatoma hospitalized between 1991 and 2005 were retrospectively studied.Results Sixteen cases presented profound hearing loss and one case presented mixed hearing loss.Fifteen cases were complicated with facial paralysis.Among them,lesion was located at labyrinth in eleven cases and at vertical segment in one case.On the images of computerized tomography（CT）,cholesteatoma showed a expansive lesion in petrous apex.Six patients received operation by the translabyrinth approach and eight by trans-middle cranial fossa.The surgery was performed in other three cases by the combined approach of trans-middle cranial fossa and trans-labyrinth.Extended resection of temporal bone was applied to two cases,whole course facial nerve decompression to four cases,end-to-end facial nerve neurorrhaphy to five cases,and hypoglossus-facial nerve neurorrhaphy to one case.All the cases reached complete recovery.There were no recurrence and infection.Conclusion The incidence of petrous apex cholesteatoma is low.There is no obvious early-stage symptoms.Mid-late stage symptoms include facial spasm and otopyosis.CT and magnetic resonance imaging（MRI）of temporal bone play the important role in the diagnosis of petrous apex cholesteatoma.It is recommended that surgery decompression be carried out as soon as possible since a confirmed prognosis is obtained,avoiding cerebrospinal fluid infection and further damage of facial-acoustic nerve.Surgical approaches rely on the location and the extent of lesion.