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目的 探讨提高大型听神经瘤（LAN）的手术切除效果及对面神经的功能保护。方法作者分析了230例LAN（直径>30mm）患者手术前后的临床特征。本组均经CT或MRI扫描诊断,采取经枕下-乙状窦后入路并应用显微外科技术对肿瘤行切除术。结果186例（80.9％）获全切除,33例（14.3％）次全切除,余11例（4.8％）为部分切除,术后3例（1.3％）死亡。术中面神经解剖学保留率为82.6％（190例）。203例经长期随访观察（平均3.8年）,其中191例（94.1％）恢复良好。结论 采用显微外科技术经枕下-乙状窦后入路切除LAN,使面神经获得了较好的解剖学保留与功能保存,对>30mm直径的听神经瘤,作者推荐应用该入路和显微外科技术进行切除,疗效满意。
Objective To investigate the surgical resection effect of large acoustic neuroma (LAN) and the functional protection of the facial nerve. Methods The authors analyzed the clinical characteristics of 230 patients with a diameter of 30 mm (LAN) before and after surgery. This group were diagnosed by CT or MRI scan, taken after suboccipital-sigmoid sinus approach and the application of microsurgery resection of the tumor. Results Total excision was performed in 186 cases (80.9%) and total excision in 33 cases (14.3%). Partial resection was performed in 11 cases (4.8%) and in 3 cases (1.3%) after the operation. Intraoperative facial nerve anatomy retention rate was 82.6% (190 cases). A total of 203 patients were followed up for a long period of time (mean, 3.8 years), of which 191 (94.1%) recovered well. Conclusions Microsurgery is used to remove the LAN via the suboccipital-sigmoid sinus posterior approach to obtain good anatomical retention and functional preservation of the facial nerve. For the treatment of acoustic neuroma> 30 mm in diameter, the authors recommend the use of this approach and microscopy Surgery to remove, the effect is satisfactory.