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目的评价听神经瘤术中恰当磨除内听道后上壁的处理策略及临床意义。方法对重庆医科大学附属第一医院神经外科自2007年9月至2012年9月手术治疗的135例听神经瘤患者进行回顾性分析。手术皆采用枕下-乙状窦后入路。术中采用高速微型磨钻充分磨除内听道后上壁,开始时使用钢切削钻进行磨除,在骨质部分磨除后,改用金钢砂磨头精细磨除。主要磨除内听道后壁,有高位颈静脉球时,需小心避开。结果 135例T3a～T4b听神经瘤患者,手术全切者125例(92.6%),次全切除者8例(5.9%),大部分切除者2例(1.5%)。面神经解剖保留126例(93.3%),术后半年面神经功能评价,面神经功能保留82例(60.7%)[HB分级,Ⅰ～Ⅱ级者14例(17.1%),Ⅲ级者68例(82.9%)]。脑脊液漏5例(3.7%),其中4例经保守治疗痊愈(3.0%),1例经内听道后壁磨除修补后痊愈(0.7%)。吞咽呛咳7例(5.2%),共济失调6例(4.4%),死亡1例(0.7%)。结论术前进行充分有效的评估,术中磨除内听道后上壁可有效提高肿瘤的全切率,同时提高面神经的功能保留率。
Objective To evaluate the treatment strategy and clinical significance of upper wall after proper removal of internal auditory canal in acoustic neuroma. Methods A retrospective analysis was performed on 135 patients with acoustic neuroma surgically treated in Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from September 2007 to September 2012. Surgery are used suboccipital sigmoid sinus approach. Intraoperative use of high-speed mini-grinding fully worn after the removal of the upper wall after the auditory canal, the beginning of the use of steel cutting drill for grinding and removal of the bone after partial removal, the use of fine grinding grit removal. The main wall after removal of the auditory canal, high jugular bulb, be careful to avoid. Results Among 135 patients with T3a ~ T4b acoustic neuroma, 125 cases (92.6%) underwent total surgical resection, 8 cases (5.9%) underwent subtotal resection and 2 cases (1.5%) underwent resection. There were 126 cases (93.3%) with facial nerve anatomy and 82 cases (60.7%) with functional facial nerve preservation after facial nerve preservation [HB classification, 14 cases (17.1%) in grade Ⅰ ~ Ⅱ and 68 cases (82.9% )]. Cerebrospinal fluid leaked in 5 cases (3.7%), of which 4 cases were cured by conservative treatment (3.0%), and 1 case recovered by mural repair of the internal auditory canal (0.7%). 7 cases (5.2%) swallowed and cough, ataxia in 6 cases (4.4%) and death in 1 case (0.7%). Conclusions The full and effective preoperative assessment of intraoperative and surgical removal of the upper wall of the internal auditory canal can effectively improve the rate of tumor resection while increasing facial nerve function retention rate.