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目的 探讨大型听神经瘤的诊断、经枕下 乙状窦后入路显微手术切除及预后价值。方法采用CT或MRI扫描检查和显微外科技术 ,作者对 316例大型听神经瘤行系列手术切除。术中及术后评估面神经的功能。结果 本组肿瘤 2 5 5例 (86 .4 % )达到全切除 ,4 3例 (13.6 % )获次全切除。术后 5例 (1.6 % )死亡 ,面神经的解剖学保留率为 78.8% (2 4 9例 )。根据House Brachman面神经分级标准 ,对 2 5 8例进行 1年的随访评估 ,面神经功能获得满意恢复者 (I～IV级 )为 2 2 5例 (87.2 % )。结论 采用显微技术切除大型听神经瘤 ,对面神经可获得解剖学与功能的保护 ,并发症与死亡率很低 ,临床疗效满意
Objective To investigate the diagnosis of large acoustic neuroma and microsurgical resection and prognostic value of suboccipital sigmoid sinus posterior approach. Methods CT or MRI scans and microsurgical techniques were used. The authors performed series of surgical resections on 316 patients with large acoustic neuroma. Intraoperative and postoperative assessment of facial nerve function. Results Twenty-five (86.4%) tumors in this group achieved total resection and 43 (13.6%) achieved total resection. Five patients (1.6%) died after operation, and the anatomic retention rate of facial nerve was 78.8% (299 cases). According to the House Brachman Facial Nerve Grading Standard, 25-year follow-up assessment of 258 patients showed satisfactory restoration of facial nerve function (grade I to IV) of 225 (87.2%). Conclusion Microsurgical resection of large acoustic neuroma allows the facial nerve to be anatomically and functionally protected with low complication and mortality and satisfactory clinical outcome