枕下乙状窦后锁孔入路显微手术切除大型听神经鞘瘤

目的 探讨经枕下乙状窦后锁孔入路显微手术切除大型听神经鞘瘤的手术技巧和临床疗效.方法 采用该入路对59例大型(≥3 cm)听神经鞘瘤行显微手术切除,术中通过调节显微镜角度和手术床位置充分显露肿瘤并切除,然后严密缝合硬脑膜,骨瓣复位固定.结果 肿瘤全切除53例(89.8%),次全切除6例(10.2%),全组无死亡患者,面神经均获解剖保留.术后出现轻、中度面瘫者45例(76.3%),部分听力残存15例,无切口局部脑脊液漏或皮下积液.结论 枕下乙状窦后锁孔入路显微手术是切除大型听神经鞘瘤的较好方法,死亡率和病残率低,并能有效保留面、听神经的功能.

Microsurgical excision of large acoustic neurinoma via suboccipital retrosigmoid keyhole approach

Objective To explore the surgical skills and efficacy of microsurgical excision of large acoustic neurinoma via the suboccipital retrosigmoid keyhole approach. Methods Fifty-nine patients with large acoustic neurinoma (≥3 cm) underwent microsurgical resection via suboccipital retrosigrmoid keyhole approach. The intraoperative position of the operative bed and angle of the microscope were adjusted to expose the tumors sufficiently. The duramater was sutured tightly and the bone flap was replaced and fixed. Results Of the 59 patients, 53 (89.8%) received a total resection of the tumors, and 6 (10.2%) subtotal resection. No patient died. The facial nerve was anatomically preserved in all the patients. Forty-five patients (76.3%) suffered from mild or moderate facial palsy after the surgery, and the symptoms were improved significantly after expectant treatment. Fifteen patients preserved partial hearing. No subcutaneous water accumulation or cerebrospinal fluid leakage occurred.Conclusion Microsurgery via suboccipital retrosigmoid keyhole approach is a favorable treatment for large acoustic neurinomas with low morbidity and mortality,which can effectively protect the function of the acoustic and facial nerves.