大型囊性听神经瘤的临床特点及显微手术治疗

目的 探讨大型囊性听神经瘤的临床特征,总结显微手术治疗经验.方法 对经显微手术治疗的24例大型囊性及50例大型实性听神经瘤进行回顾性对比分析.结果 囊性肿瘤全切17例(71%),次全切6例(25%),大部切除1例(4%),面神经解剖保留20例(83%).实性肿瘤全切45例(90%),次全切5例(10%),面神经解剖保留45例(90%).囊性肿瘤首发症状多不典型,病程短,脑积水发生率高.结论 大型囊性听神经瘤发展迅速,应及时手术治疗.应用显微外科技术,对与神经组织紧密粘连的肿瘤,采取次全切除的策略,有助于面神经的保护,提高临床效果.

Large cystic acoustic neuromas:clinical characteristics and microsurgical treatment

Objective To study the clinical characteristics,surgical strategy and outcomes of large cystic acoustic neuromas based on our experience.Method A retrospective study of clinical presentation and surgical outcomes was performed on 74 patients with large acoustic neuromas, of which 24 were cystic and 50 were solid.Results Atypical initial symptoms, shorter clinical history and more frequent incidence of preoperative hydrocephalus were characteristics of large cystic acoustic neuromas differed from solid tumors.Gross total resection was performed in 17(71%) patients with cystic tumors and 45(90%) patients with solid tumors, subtotal resection in 6 (25%) and 5 (10%),respectively.The anatomical preservation of facial nerve was achieved in 20 patients (83%) with cystic tumors versus 45 patients (90%) with solid tumors.Conclusions Large cystic acoustic neuromas have a rapid growth pattern and should be given early surgical treatment.The surgical strategy of subtotal resection is indicated for large cystic acoustic neuromas with severe adherence in order to preserve facial nerve function.