枕下乙状窦后入路听神经瘤切除手术中的面神经保护策略

听神经瘤是常见的颅内肿瘤，占桥脑小脑角肿瘤的80%~90%，显微外科手术治疗是其主要治疗方法，枕下乙状窦后入路是最常用的手术入路，面神经保护是听神经瘤手术的重要目标之一。为了保护面神经，需对患者术前面神经功能进行准确评估，熟知面神经在桥脑小脑角池和内听道内的走行方式及其变化，术中需适当磨除内听道后壁骨质，充分降低颅内压力和肿瘤内减压，遵循神经束膜下分离和双向分离原则，并尽量减少双极电凝的使用，而面神经监护需贯穿于整个听神经瘤的暴露和切除过程。

The Strategy of Facial Nerve Preservation in Acoustic Neuroma Surgery via Suboccipital Retrosigmoid Approach

Acoustic neuroma is a common intracranial tumor, with a prevalence of 80-90% in the lesions of cerebellopontine angle. Microsurgical removal remains its main therapy, and the retrosigmoid approach continues to be the most widely employed strategy for the surgical resection of acoustic neuromas, with preservation of facial nerve to be the important goal. In order to preserve the facial nerve, the facial nerve's function should be evaluated accurately before and after the operation. The course of the facial nerve and its variation in cerebellopontine cistern and internal auditory canal should be well understood. Adequate drilling of the posterior wall of the internal auditory canal is necessary. Sufficient decompression of intracranial pressure and the tumor is imperative. The principle of subperineural and bidirectionary dissection should be followed. The use of bipolar coagulation should decrease to the greatest extent, and facial nerve monitoring should be used throughout exposing and removal of the acoustic neuroma.