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目的探讨听神经瘤的安全切除、术中面神经保护技术及解剖学基础。方法 121例听神经瘤全部采用枕下乙状窦后入路,在显微外科基础上采用神经电生理监测技术,配合超声吸引(CUSA)和激光刀切除肿瘤,术后采用House-Brackmann(HB)分级方法对面神经功能进行评价。结果肿瘤全切除100%(121例)。面神经解剖保留93.4%(113例),蜗神经解剖保留90.1%(109例),无死亡病例。术后3个月回访121例,按House-Brackmann分级对面神经功能评估,I-II级71.9%(87例),III-IV级25.6%(31例),V-VI级3.3%(4例)。结论掌握听神经瘤与蛛网膜关系的解剖学基础是听神经瘤安全切除及面神经功能保护的关键。
Objective To investigate the safety of acoustic neuroma resection, intraoperative facial nerve protection and anatomical basis. Methods 121 cases of acoustic neuroma were all suboccipitally inserted into the sigmoid sinus. On the basis of microsurgery, neuroelectrophysiological monitoring technique was used in combination with CUSA and laser knife to excise the tumor. House-Brackmann (HB) classification was performed postoperatively Methods Facial nerve function was evaluated. Results Tumor resection 100% (121 cases). Facial nerve anatomy retained 93.4% (113 cases), cochlear nerve anatomy retained 90.1% (109 cases), no deaths. A total of 121 patients were followed up 3 months after operation. According to House-Brackmann classification, facial nerve function was assessed in 71.9% (87 cases) of grade I-II, 25.6% (31 cases) of grade III-IV and 3.3% ). Conclusion To master the anatomic basis of the relationship between acoustic neuroma and arachnoid is the key to the safe excision of acoustic neuroma and facial nerve function protection.