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目的 :探讨听神经鞘瘤复发的临床诊断要点及再次手术治疗的特点。方法 :通过对近 5年内收治的 18例复发性听神经鞘瘤患者进行回顾性分析 ,描述其复发的临床诊断要点及再次手术的体会。结果 :18例复发性听神经鞘瘤患者均经第一次手术病理证实。原手术后至症状复发确诊的时间平均为 4 2年 ,复发主要症状为颅高压及行走障碍。所有肿瘤均行显微手术切除 ,术中采用内窥镜及CUSA辅助手术 ,全切 15例 (全切率 83% ) ,次全切 3例。 12例再次手术前面神经保留者术后 8例继续得到解剖保留。结论 :听神经鞘瘤患者原手术后症状及体征缓解或消失 ,再次出现颅高压及行走障碍等症状体征或加重者 ,应高度怀疑肿瘤复发 ,动态MRI检查是早期诊断复发的主要手段和客观依据。良好的术野暴露及辅以内窥镜及超声吸引技术的显微手术可使复发性听神经鞘瘤再次手术仍可获得较满意的治疗效果
Objective: To investigate the clinical diagnosis of recurrent schwannoma and the characteristics of reoperation. Methods: A retrospective analysis of 18 patients with recurrent schwannoma treated during the past five years was performed to describe the clinical diagnosis and reoperation experience of recurrent. Results: 18 patients with recurrent schwannoma were confirmed by the first surgical pathology. The original diagnosis of recurrent symptoms to the average time of 42 years, the main symptoms of recurrence of intracranial hypertension and walking disorders. All tumors underwent microsurgical resection. Endoscopic and CUSA assisted surgery was performed in all the cases. Total resection was done in 15 cases (total resection rate 83%) and subtotal resection in 3 cases. Twelve of the 12 cases underwent reoperation of the anterior facial nerve retainer were continued to receive anatomic retention. Conclusions: Patients with schwannoma should relieve or disappear the symptoms and signs of the original surgery, and the symptoms or exacerbation of symptoms such as intracranial hypertension and walking disorders again should be highly suspected. The dynamic MRI examination is the main means and objective basis for the early diagnosis of relapse. Good surgical field exposure and microsurgery supplemented by endoscopic and ultrasonic aspiration techniques can still give satisfactory treatment for recurrent schwannoma