大型听神经瘤的显微手术治疗

目的探讨经枕下乙状窦后入路显微手术切除大型听神经瘤的效果。方法回顾性分析我院2008年1月至2011年12月手术切除的大型听神经瘤182例患者的临床资料。手术采用侧卧位单侧枕下乙状窦后入路。结果肿瘤全切除162例（89.0%）,次全切除12例,大部切除8例。术中面神经解剖保留率为92.3%（168/182）,术后1周面神经功能保留率为69.8%（127/182）。术后死亡4例。术中行神经电生理监测48例中面神经功能保留率为89.5%（43/48）,较同期未监测患者面神经保留率（70.0%,14/20）明显提高（P〈0.05）。146例术后随访3个月至1年,面神经功能保留121例（82.9%）。结论采用枕下乙状窦后入路显微手术切除大型听神经瘤手效果确切,术中神经电生理监测可有效提高面神经的功能保留率。

Microsurgery via suboccipito retrosigmoid approach for large acoustic neuromas

ObjectiveTo report our experience in treating large acoustic neuromas by microsurgery through suboccipito retrosigmoid approach.MethodsThe clinical data of 182 patients with large acoustic neuroma, who underwent microsurgery through suboccipital retrosigmoid approach from January 2008 to December 2011, were analyzed retrospectively. Forty-eight patients received intraoperative electrophysiological monitoring and 20 did not use from October 2012 to December 2011.ResultsTotal resection was achieved in 162 patients（89.0%）, subtotal in 12 and partial in 8. The anatomical preservation rate of the facial nerve was 92.3%（168/182）. The facial nerve function was preserved in 127 patients（69.8%） one week after operation. Four patients died after operation. The functional preservation rate of the facial nerve（89.5%, 43/48） was significantly higher in the patients receiving intraoperative neurophysiological monitoring than those did not（70.0%, 14/20;P0.05）. One hundred and forty-six patients were followed up for 3~12months; the functional preservation rate of the facial nerve was 82.9%.ConclusionsMicrosurgery through suboccipito retrosigmoid approach is an effective method for large acoustic neuromas. The intraoperative neurophysiological monitoring helps to increase the functional preservation rate of the facial nerve.