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目的探讨经枕下乙状窦后锁孔入路切除大型前庭神经鞘瘤的治疗策略和显微外科手术。方法回顾性分析2010年1月至2012年9月采用经枕下乙状窦后锁孔入路手术治疗的大型前庭神经鞘瘤37例患者的临床、影像学、手术过程及随访资料。结果 37例神经鞘瘤均经病理证实,无死亡及发生严重并发症的病例。肿瘤次全切除1例,大部切除1例,全切35例。全切率94.6%。37例患者面神经均获得解剖保留,解剖保留率100%。术后3~6个月随访,HB分级:Ⅰ级9例,Ⅱ~Ⅲ级26例,Ⅳ级2例。术后3例患者有不同程度的听力保留,3个月后随访电测听听力在60~70 dB,基本恢复至术前水平。结论经枕下乙状窦后锁孔入路能有效的提供桥小脑角的显露空间,可提高大型前庭神经鞘瘤的全切率和面神经功能的保留级别。
Objective To investigate the treatment strategy and microsurgery for the resection of large schwannoma schwannoma through the suboccipital sigmoid posterior keyhole approach. Methods A retrospective analysis of clinical, imaging, surgical procedures and follow-up data of 37 patients with large vestibular schwannoma treated by suboccipital retro-sigmoid sinus surgery from January 2010 to September 2012 was performed. Results Thirty-seven schwannomas were confirmed by pathology without any death or serious complications. Tumor subtotal resection in 1 case, most resection in 1 case, complete resection in 35 cases. Full cut rate of 94.6%. The facial nerve of 37 patients was anatomically preserved and the anatomic retention rate was 100%. After 3 to 6 months follow-up, HB grade: grade Ⅰ in 9 cases, Ⅱ ~ Ⅲ grade in 26 cases, Ⅳ grade in 2 cases. Three patients had different degrees of hearing retention after 3 months of follow-up electrical audiometry hearing at 60 ~ 70 dB, the basic return to preoperative level. Conclusions Transocephaly posterior sigmoid sinus approach can effectively provide the exposed space of cerebellopontine angle, which can improve the total cut rate of facial vestibular schwannoma and preserve the facial nerve function.