大型听神经瘤显微外科治疗

目的探讨大型听神经瘤的诊断、经枕下-乙状窦后入路显微手术切除及预后价值.方法采用CT 或 MRI扫描检查和显微外科技术,作者对316例大型听神经瘤行系列手术切除.术中及术后评估面神经的功能.结果本组肿瘤255例(86.4%)达到全切除,43例(13.6%) 获次全切除.术后5例(1.6%)死亡,面神经的解剖学保留率为78.8%(249例).根据House-Brachman面神经分级标准,对258例进行1年的随访评估,面神经功能获得满意恢复者(I～IV级)为225例(87.2%).结论采用显微技术切除大型听神经瘤,对面神经可获得解剖学与功能的保护,并发症与死亡率很低, 临床疗效满意.

Microsurgical management of large acoustic neuromas

Objective To evaluate the effect of diagnosis, microsurgical resection, and prognosis of the large acoustic neuromas (LANs) via a suboccipital retrosigmoid approach.Methods Using the CT or MRI scanning and microsurgical techniques, the authors conducted a series of surgeries for 316 cases of patients with LANs. The intraoperative and postoperative facial nerve function was evaluated.Results Total tumor removal was accomplished in 255 cases (86.4%) and subtotal tumor removal in 43 cases (13.6%) in this series. There were 5 cases (1.6%) of death after surgery. The facial nerve was preserved anatomically in 249 (78.8%) of the patients. According to the House-Brachman facial nerve grading system, acceptable function (grade I～ IV) were obtained in 87.2% (225/258 cases) by the time of follow-up assessment one year later.Conclusion Use of the microsurgical techniques for removing the LANs resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and low mortality, and its clinical effect is satisfactory.