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目的探讨经扩大迷路径路大型听神经瘤切除术的显微手术技巧及效果。方法回顾性分析2013年1~4月收治的4例大型听神经瘤患者的临床资料,所有患者均采用扩大迷路径路显微手术治疗,术中面神经解剖保留3例,1例患者行面神经端端吻合。术后随访6~10个月。结果本组4例大型听神经瘤患者肿瘤直径均≥5cm,最大为8cm,3例为重度感音神经性聋,1例高频听力下降;伴失明1例。术后复查内听道MRI显示肿瘤均全部切除,术后6个月随访时,2例面神经功能正常,1例患者面神经功能由Ⅲ级恢复到Ⅱ级,1例行面神经吻合的患者面神经功能由Ⅵ级恢复到Ⅳ级,1例伴失明的患者视力完全恢复正常。结论扩大迷路径路显微外科手术可以完全切除大型听神经瘤,并可部分或全部保留面神经功能。
Objective To explore the microsurgical skills and effects of large acoustic neuroma resection by enlarging the lost path. Methods The clinical data of 4 patients with large acoustic neuroma admitted from January to April in 2013 were retrospectively analyzed. All patients underwent microsurgical treatment with enlarged vagus nerve pathology. Three cases were treated with intraoperative facial nerve anatomy and one patient had facial nerve anastomosis . Postoperative follow-up 6 to 10 months. Results The tumors of 4 patients with large acoustic neuroma had a diameter of 5 cm or more, a maximum of 8 cm, 3 patients with severe sensorineural hearing loss, 1 patient with high frequency hearing loss and 1 patient with blindness. All the tumors were resected in the auditory canal after operation, and the facial nerve function was normal in 2 cases at 6 months after operation. The facial nerve function recovered from 1 case to Ⅱ level in 1 case. The facial nerve function in 1 case of facial nerve anastomosis Ⅵ level recovered to grade Ⅳ, 1 patient with blindness completely returned to normal. Conclusion Enlargement lost path microsurgery can completely remove large acoustic neuroma, and can retain facial nerve function partially or completely.