摘要
目的探讨巨大型听神经瘤的显微外科治疗及面神经保护效果。 方法2005年1月－2013年1月，采用标准枕下乙状窦后入路辅助神经电生理监测下行显微外科切除术治疗400例巨大型听神经瘤患者。其中男186例，女214例；年龄15～74岁，平均41.6岁。病程2～13年，平均2.4年。病变均位于桥小脑角区，其中左侧191例，右侧200例，双侧9例。临床表现：单侧听力下降伴耳鸣为首发症状389例，面部麻木373例，单侧面瘫370例，头痛269例，饮水呛咳、吞咽困难等后组颅神经症状317例，行走不稳342例。术前颅底薄层CT示患侧内听道口均有不同程度“喇叭口”样扩大。MRI示肿瘤为囊性78例，实性322例；合并脑积水269例。术后复查头部MRI或CT了解肿瘤切除程度。术中显微镜观察及电生理监测评定面神解剖保留情况，术后当天根据House-Brackmann（HB）分级评定面神经功能保留情况，以及出院时和术后1年按HB分级评价面神经功能。 结果肿瘤全切372例（93.00%），次全切除28例（7.00%）。1例术后14 d因迟发性脑干缺血死亡，1例术后20 d因肺部感染死亡；余398例获随访，随访时间6个月～8年，平均3.5年。1例因神经纤维瘤病5年后复发。术中面神经解剖保留367例（91.75%）；术后当天面神经功能保留251例（62.75%），术后当天、出院时及术后1年间面神经功能HB分级比较差异有统计学意义（χ2=23.432，P=0.000）。术后发生颅内感染11例（2.75%），脑脊液漏29例（7.25%），后组颅神经症状加重18例（4.50%），皮下积液13例（3.25%），创腔出血需二次手术9例（2.25%），口周单纯疱疹病毒感染25例（6.25%），均经对症处理后治愈。术前合并脑积水者，术后261例脑积水消失。 结论经枕下乙状窦后入路辅助神经电生理监测下行显微外科手术患者死亡率极低，面神经功能保留率较高，是巨大型听神经瘤的首�
Objective To analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. Methods Under the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years （mean, 41.6 years）. The disease duration was 2-13 years （mean, 2.4 years）. The lesions were located at the left cerebellopontine angle region （CPA） in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn -like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann （HB） classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. Results Total tumor removal was achieved in 372 cases （93.00%）, and subtotal removal in 28 cases （7.00%）. One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years （mean, 3.5 years）. Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomic
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第1期79-84,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
巨大型听神经瘤
显微外科
面神经
电生理监测
Giant acoustic neuroma Microsurgery Facial nerve Electrophysiological monitoring
