摘要
目的探讨Ⅱ型神经纤维瘤病(neurofibromatosis type 2,NF2)微创手术治疗经验。方法回顾性分析(包括伽玛刀治疗后,肿瘤增大或囊性变扩大2侧)经微创显微手术治疗16例NF2患者的临床资料。根据肿瘤大小、听力损伤程度选择手术切除时机和肿瘤侧别,经枕下乙状窦后-内听道入路切除听神经瘤,术中面神经、三叉神经和听觉脑干反应监测。结果双侧听神经瘤9例均分期分侧切除,单侧听神经瘤切除7例,共切除25侧听神经瘤(2侧肿瘤未行手术)。全切除肿瘤22侧(22/25,88%),另3侧肿瘤近全切除(为唯一存在听力耳)。椎管内神经鞘瘤3例和颅内脑膜瘤1例,均获得肿瘤全切除。近全切除的3侧听神经瘤和尚未行肿瘤切除的2侧听神经瘤(尚存有效听力),术后辅助伽玛刀治疗。术前残存有效听力的11侧耳,术后保留不同程度的听力5侧,听力保留率为45.5%(5/11)。术中解剖保留面神经者23侧(23/25,92.0%),半年后复查显示面神经功能H-BI~Ⅲ级的有23侧,H-BⅣ级2侧。术后无死亡和严重并发症。结论Ⅱ型神经纤维瘤的微创手术治疗应根据双侧肿瘤的大小、听力水平、解除脑干压迫的迫切性、肿瘤的生长速度和是否合并其他肿瘤,来共同制定个体化的手术方案,选择最佳的肿瘤切除的时机、肿瘤侧别和肿瘤类型。
Objective To explore the experience of minimally invasive microsurgical treatment for neurofibromatosis typeⅡ(NF2).Methods The clinical data of 16 consecutively NF2 patients who underwent minimally invasive microsurgical treatment for vestibular schwannoma removal were retrospective analyzing,including tumor enlargement or cystic enlargement 2 sides after gamma knife treatmen.According to the size of the tumor,the degree of hearing damage,the timing of surgical resection and the side of the tumor were selected.The posterior suboccipital sigmoidsinus tran-acoustic approach was used to remove the acoustic neuroma.The facial nerve,trigeminal nerve and auditory brainstem response were monitored.Results Staging side resection of bilateral acoustic neuroma in 9 cases,unilateral acoustic neuroma resection in 7 cases.A total of 25 acoustic neuromas were removed(2 tumors were not operated).The tumor was completely resected on the 22 side(22/25,88%),and subtotal resection were be done in 3 sides tumor(effective hearing ear only).Intraspinal schwannoma resection in 3 cases,1 case of intracranial meningioma resection,total resection of the tumor was achieved in all.Three sides of tumor subtotal of the tumor and 2 side tumors without undergoing tumor resection(surviving effective listening),postoperative adjuvant gamma knife treatment.Eleven ears with residual effective hearing before operation,postoperative 5 ears retained different degrees of hearing,the postoperative hearing preservation rate was 45.5%(5/11).Twenty-three sides of the tumor were anatomically preserved facial nerve(23/25,92%),facial nerve function H-BⅠ-Ⅲlevel were preserved on the 23 side after 6 months postoperation,H-BⅣ2 sides.No postoperative death and serious complications.Conclusion Minimally invasive surgery for typeⅡneurofibromatosis should be based on the size of the bilateral tumor,the level of hearing,the urgency of relieving brain stem compression,the growth rate of the tumor,and whether other tumors are combined,to design an individuali
作者
陈立华
徐如祥
李运军
李文德
于斌
高进宝
Chen Lihua;Xu Ruxiang;Li Yunjun;Li Wende;Yu Bin;Gao Jinbao(Affiliated BaYi Brain Hospital,Seventh Medical Center of General Hospital of PLA,Beijing 100700,China)
出处
《中华脑科疾病与康复杂志（电子版）》
2019年第1期10-14,共5页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
关键词
前庭神经鞘瘤
Ⅱ型神经纤维瘤病
微创技术
神经功能保护
Vestibular schwannoma
Neurofibromatosis type 2
Minimally invasive technique
Nerve function preservation
