复发性听神经鞘瘤的诊断和手术治疗

目的 :探讨听神经鞘瘤复发的临床诊断要点及再次手术治疗的特点。方法 :通过对近 5年内收治的 18例复发性听神经鞘瘤患者进行回顾性分析 ,描述其复发的临床诊断要点及再次手术的体会。结果 :18例复发性听神经鞘瘤患者均经第一次手术病理证实。原手术后至症状复发确诊的时间平均为 4 2年 ,复发主要症状为颅高压及行走障碍。所有肿瘤均行显微手术切除 ,术中采用内窥镜及CUSA辅助手术 ,全切 15例 (全切率 83% ) ,次全切 3例。 12例再次手术前面神经保留者术后 8例继续得到解剖保留。结论 :听神经鞘瘤患者原手术后症状及体征缓解或消失 ,再次出现颅高压及行走障碍等症状体征或加重者 ,应高度怀疑肿瘤复发 ,动态MRI检查是早期诊断复发的主要手段和客观依据。良好的术野暴露及辅以内窥镜及超声吸引技术的显微手术可使复发性听神经鞘瘤再次手术仍可获得较满意的治疗效果

DIAGNOSIS AND OPERATION OF RECURRENT ACOUSTIC NEURINOMA

Objective:To discuss the clinical diagnosis points and re-operation character of the recurrent acoustic neurinoma.Methods:The clinical diagnosis points and re-operation experience of consecutive 18 cases with the recurrent tumor,treated from Jan.1997 to Jan.2002 in our department,were reviewed.Results:The patients were confirmed as acoustic nerinoma by the pathology after the first surgery.The recurrent period was 4 2 years average.The main symptoms were high intracranial pressure and disturbance of walking.Of all the patients in our group,total tumor removal was achieved in 15 patients(15/18,83%),subtotal removal in 3.Among the 12 patients which the facial nerve had been normal after the first operation,8 patients were still completed conserved.The operations were under the microsurgery, nero-endoscope and CUSA.Conclusions:After the first operation,the high intracranial pressure and the disturbance of walking appeared again,and recurrence of tumor should be doubted.The dynamic MRI is the main tool for early diagnosing the recurrent nerinoma. A good surgical exposure and the neuro-microsurgery assisted by neuro-endoscope and CUSA must be conducive to comfortable results.