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目的 :探讨通过扩大的迷路进路切除巨大听神经瘤的手术方法和手术效果。 方法 :扩大迷路进路的要点是 ,充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜 ,暴露并下压颈静脉球 ,内听道周围骨质 2 70°以上切除。肿瘤切除应从前下极处开始 ,以早期暴露脑干及脑干表面面神经 ,随后即可从内侧向外侧解剖面神经。术中均使用面神经监护仪 ,术后均复查CT和 MRI。结果 :18例直径在 3cm以上的听神经瘤 (平均直径 4.2 cm) ,均能手术全切 ,脑组织无明显损伤 ,2例术后一过性脑脊液漏自愈 ,无颅内感染 ;面神经解剖及功能保存 14例 ,其中 8例面神经功能 1～ 2级 (4 4% ) ,6例面神经功能 3～ 4级(33% ) ,4例面神经中断者均为术前已有重度面瘫或已中断 ;16例术后 1～ 3月恢复工作 ,2例恢复生活自理。结论 :经扩大迷路进路既能达到全切巨大听神经瘤的目的 ,同时具有损伤小、面神经保存率高的优点
OBJECTIVE: To explore the surgical method and surgical results for the removal of giant acoustic neuroma by enlarging labyrinthine approach. Methods: The key point of enlarging the path of getting lost was to fully expose the sigmoid sinus and its posterior dura, petrosal sinus and middle cranial fossa dura, expose and press the jugular bulb, and remove the bone around the internal auditory canal more than 2 70 °. Tumor resection should start from the former pole to early exposure of the brainstem and brainstem facial nerve, then you can from the medial to the lateral anatomical nerves. Surgery were used facial nerve monitor, postoperative review of CT and MRI. Results: Eighteen patients with acoustic neuroma (average diameter of 4.2 cm) with a diameter of more than 3 cm were able to be surgically removed without any significant damage to the brain tissue. Two patients had a recurrent cerebrospinal fluid leakage and no intracranial infection. Facial nerve anatomy and Fourteen cases were preserved in function, including facial nerve function grade 1 ~ 2 (4 4%) in 8 cases and facial nerve function grade 3 ~ 4 grade 6 (33%) in 6 cases. Sixteen patients recovered from 1 month to 3 months after operation, and 2 patients recovered themselves. Conclusions: The enlarged lost lost path can achieve the purpose of completely cutting huge acoustic neuroma, meanwhile it has the advantages of small damage and high facial nerve preservation rate