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目的 探讨手术切除大型听神经瘤 (LAN)的最佳入径。 方法 对术前经CT或MRI证实 ,且肿瘤位于桥脑小脑角区 ,直径≥ 31mm的 2 16例LAN患者 ,采用枕下 乙状窦后入路显微手术肿瘤切除术 ;术后评估治疗效果 ,分别比较术前、后的听神经和面神经功能。 结果 肿瘤全切除率79 6 % (172例 ) ;次全切除率 15 3% (33例 ) ;部分切除率 5 1% (11例 ) ;术后病死率 1 4% (3例 )。听神经解剖保留率为 12 5 % (2 7例 ) ,出院时功能保留率为 4 2 % (A级 ,9例 ) ;面神经解剖保留率为 82 4%(178例 ) ,出院时功能保留率为 5 2 8% (House分级 ,Ⅰ～Ⅱ级 94例 )。对 187例患者平均随访 3 9年 ,其中 12 8例 (6 8 4% )恢复良好 ,44例 (2 3 5 % )恢复一般 ,15例 (8 0 % )恢复较差。在恢复较差患者中有 10例 (5 4% )肿瘤复发 (再次手术治愈 )。 结论 经枕下 乙状窦后入路显微手术切除大型听神经瘤是一种安全、有效的方法。
Objective To investigate the optimal diameter of surgically excised large acoustic neuroma (LAN). Methods Twenty-six patients with LAN whose tumors were located in the cerebellopontine angle region of the cerebellopontine angle and confirmed by CT or MRI preoperatively underwent microsurgical resection of the submandibular sigmoid sinus. The postoperative therapeutic effect was evaluated , Respectively, before and after the auditory nerve and facial nerve function. Results The total resection rate was 79.6% (172 cases). The subtotal resection rate was 15.3% (33 cases). The partial resection rate was 51% (11 cases). The postoperative mortality rate was 4% (3 cases). The anatomic retention rate of auditory nerve was 125% (27 cases). The functional retention rate at discharge was 42% (A grade, 9 cases). The facial nerve anatomy retention rate was 82.4% (178 cases) 528% (House classification, Ⅰ ~ Ⅱ grade 94 cases). A total of 187 patients were followed up for an average of 39 years. Among them, 128 (68.4%) recovered well, 44 (23.5%) recovered and 15 (80%) recovered poorly. Among the patients with poor recovery, 10 (54%) had tumor recurrence (again surgically cured). Conclusions Transcervical sigmoid sinus posterior approach microsurgical resection of large acoustic neuroma is a safe and effective method.