摘要
目的探讨听神经瘤显微外科切除的手术策略,以提高肿瘤的全切除率和面神经功能保护率。方法解放军总医院第七医学中心神经外科自2008年1月至2016年12月采用显微外科手术治疗听神经瘤患者415例,术后常规行MRI增强检查判断肿瘤的切除程度及应用Karnofsky行为状态评分(KPS)评估患者的预后。术后3个月采用House-Brackmann面神经功能分级(H-B)评估患者的面神经功能。结果KPS评分显示患者预后优399例(96.10%),良14例(3.37%),差2例(0.48%);肿瘤直径越大,患者预后优者占比越小。术后MRI增强检查显示肿瘤全切除387例(93.25%),次全切除24例(5.78%),部分切除4例(0.96%);肿瘤直径越大,全切除者占比越小。术中面神经解剖保留398例(95.90%),未能保留17例(4.09%),其中12例患者术中行面神经端-端吻合。术后3个月H-B分级显示Ⅰ~Ⅱ级334例(80.5%),Ⅲ~Ⅳ级76例(18.3%),Ⅴ~Ⅵ级5例(1.2%);肿瘤直径越大,患者H-B分级Ⅰ~Ⅱ级者占比越小。无手术相关死亡病例。结论早期诊断、早期手术治疗有助于提高听神经瘤显微外科切除的安全性和疗效。
Objective To explore the surgical strategy of minimally invasive treatment for acoustic neuroma and to improve the tumor removal rate and facial nerve function preservation rate. Methods Four hundred and fifteen patients suffering from acoustic neuromas, admitted to and treated by minimally invasive surgery via trans-suboccipital retrosigmoid transmeatus approach in our hospital from January 2008 to December 2016, were chosen in our study. Their clinical data were analyzed retrospectively. Postoperative Karnofsky behavioral status scale (KPS) was used to evaluate the prognoses of the patients. Postoperative routine enhanced MR imaging was performed to determine the degrees of tumor resection. Three months after surgery, House-Brackmann facial function grading (H-B) was used to evaluate the facial function of all patients. Results KPS indicated that excellent prognosis was noted in 399 patients (96.10%), good prognosis in 14 (3.37%), and poor prognosis in 2 (0.48%);the larger the tumor diameter, the smaller the proportion of patients with good prognosis. Total resection of the tumors was achieved in 387 patients (93.25%), sub-total resection in 24 (5.78%), and partial resection in 4 (0.96%);the larger the tumor diameter, the smaller the proportion of patients with total resection. There were 398 patients with facial nerve preservation in anatomy, and the anatomic preservation rate of facial nerve was 95.9%;there were 17 without anatomic preservation, and 12 received end to end anastomosis of facial nerve. Three months after operation, H-B grading I-II was noted in 334 patients (80.5%), grading III-IV in 76 patients (18.3%), grading V-VI in 5 patients (1.2%);the larger the tumor diameter, the smaller the proportion of patients with H-B grading I-II. No surgically related deaths occurred. Conclusion Early diagnosis and early microsurgical treatment of acoustic neuroma is helpful in improving the safety and efficacy of tumor resection.
作者
陈立华
徐如祥
李文德
于斌
孙恺
赵浩
张洪钿
杨艺
Chen Lihua;Xu Ruxiang;Li Wende;Yu Bin;Sun Kai;Zhao Hao;Zhang Hongtian;Yang Yi(Department of Neurosurgery, 7th Medical Center of General Hospital of People's Liberation Army, Beijing 100700, China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2019年第3期263-267,共5页
Chinese Journal of Neuromedicine
