[1]王政刚,齐洪武,张旭东,等.枕下-乙状窦后入路显微手术切除大型听神经瘤[J].中国微创外科杂志,2007,07(7):653-655.
　Wang Zhenggang,Qi Hongwu,Zhang Xudong,et al.Microsurgical resection of large acoustic neurinoma through suboccipital retrosigmoid approach[J].Chinese Journal of Minimally Invasive Surgery,2007,07(7):653-655.
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枕下-乙状窦后入路显微手术切除大型听神经瘤()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年7期
页码:
653-655
栏目:
出版日期:
2007-07-20

文章信息/Info

Title:
Microsurgical resection of large acoustic neurinoma through suboccipital retrosigmoid approach
作者:
王政刚; 齐洪武; 张旭东; 樊丰势; 张卫宁; 程建业; 王帅; 赵亚鹏
解放军白求恩国际和平医院神经外科，石家庄050082
Author(s):
Wang Zhenggang;  Qi Hongwu;  Zhang Xudong;  et al.
Department of Neurosurgery, Bethune International Peace Hospital of PLA, Shijiazhuang 050082, China
关键词:
枕下-乙状窦后入路; 听神经瘤; 显微手术
Keywords:
Suboccipital retrosigmoid approach; Acoustic neurinoma; Microsurgery
分类号:
R739.41
文献标志码:
A
摘要:
目的探讨经枕下-乙状窦后入路显微手术切除大型听神经瘤的临床疗效和意义。方法采用枕下乙状窦后入路对49例大型（≥4 cm）听神经瘤行显微手术切除，单侧枕下乳突后“S”形皮肤切口，铣刀骨瓣成形，显微镜下行肿瘤囊内逐步切除，最后分离内听道部分，锐性剥离面神经上残存肿瘤。术前及术后分别进行面神经和听神经的功能评估。结果肿瘤全切除45例(92％)，次全切除4例(8％)，全组无死亡病例。面神经解剖保留42例(86％)，术后2周功能保留36例(73％)；听神经解剖保留7例(14％)，术后2周功能保留3例(6％)。1例手术区血肿再手术清除。37例随访0.5～5年，平均2.8年，肿瘤无复发，均参加正常工作和学习。结论枕下乙状窦后入路显微手术是切除大型听神经瘤的较好方法，肿瘤的全切率高，死亡率和病残率低，并能有效地保留面、听神经的功能。
Abstract:
ObjectiveTo evaluate the safety and efficacy of microsurgical resection of large acoustic neurinoma via the suboccipital retrosigmoid approach.MethodsFortynine patients with large acoustic neurinoma (≥4 cm) underwent microsurgical resection through suboccipital retrosigmoid approach. The craniotomy was performed by way of an unilateral Sshaped suboccipital incision. With microsurgical techniques the outmost layer of the arachnoid membrane was preserved in order to avoid damaging to the surrounding vital structures. The tumor was resected intracapsularly from the superior pole and the internal auditory meatus was finally opened. The last pieces of tumor were removed by sharp dissection from the facial nerve bidirectionally, and were resected cautiously in a piecemeal fashion.ResultsOf the 49 patients, 45 patients (92%) received a total resection of the tumors, and 4 patients (8%) subtotal resection. No patients died. The facial nerve was preserved anatomically in 42 patients (86%) and functionally in 36 patients (73%). The acoustic nerve was preserved anatomically in 7 patients (14%) and functionally in 3 patients (6%). One patient experienced a postoperative haematoma, and a reoperation was required. No recurrence was seen in 37 patients during a followup for 6 months ~ 5 years (mean, 2.8 years). These patients had recovered for normal work and daily activities.ConclusionsMicrosurgical operation through suboccipital retrosigmoid approach is a favorable treatment for large acoustic neurinomas. The procedure can improve the rate of total resection, decrease the morbidity and mortality, and effectively protect the function of the acoustic and facial nerves.

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更新日期/Last Update: 2013-12-09