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目的 :探讨通过扩大的迷路进路切除大听神经瘤的方法和效果。方法 :充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜 ,暴露并下压颈静脉球 ,内听道周围骨质 2 70°以上切除。肿瘤切除从前下极处开始 ,以早期暴露脑干及脑干表面面神经 ,随后即从内侧向外侧解剖面神经。结果 :1 8例直径在 3cm以上的听神经瘤 (平均直径 4.2 cm) ,均手术全切 ,脑组织无明显损伤。2例术后一过性脑脊液漏自愈 ,无颅内感染。面神经解剖及功能保存 1 4例 ,其中 8例面神经功能 1～ 2级 (44% ) ,6例面神经功能 3～ 4级 (33% ) ;4例面神经中断者均为术前已有重度面瘫或已中断。1 6例术后 1～ 3个月恢复工作 ,2例恢复生活自理。结论 :经扩大迷路进路既能全切大听神经瘤 ,同时又具有损伤小、面神经保存率高等优点。
Objective: To explore the method and effect of excision of large acoustic neuroma through enlarged labyrinthine approach. Methods: The sigmoid sinus and its posterior dura, petrosal sinus and middle cranial fossa dura were fully exposed, and the jugular bulb was exposed and decompressed. The bone around the auditory canal was dissected at over 2 70 °. Tumor resection begins at the lower pole, exposing the facial nerve of the brainstem and brainstem early, then dissecting the nerves from the medial to the lateral. Results: Eighteen patients with acoustic neuroma (mean diameter 4.2 cm) with a diameter of more than 3 cm were all surgically excised and no obvious brain injury. 2 cases of transient cerebrospinal fluid leakage self-healing, no intracranial infection. Facial nerve anatomy and functional preservation of 14 cases, of which 8 cases of facial nerve function of 1 to 2 (44%), 6 cases of facial nerve function 3 to 4 (33%); 4 cases of facial nerve interrupter were preoperative have severe facial paralysis or Discontinued. 1 6 cases recovered 1 to 3 months after operation, and 2 patients recovered themselves. Conclusion: The enlarged and lost path can not only completely cut down the acoustic neuroma, but also has the advantages of less damage and higher facial nerve preservation rate.