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目的探讨听神经瘤内听道的显微外科处理,提高肿瘤的全切除率和面神经的功能保留率。方法回顾性分析经枕下乙状窦后内听道入路行显微外科手术治疗听神经瘤的32例患者的临床资料,术前均行后颅窝岩骨CT薄层扫描,术中采用磨钻(美敦力公司)或磨骨刀(SONOPET公司)将内听道磨开,磨除时后壁尽量磨开,术中均行面神经功能电生理监测,对内听道内肿瘤处理的手术技巧进行分析。结果听神经瘤全切除30例,全切除率为96%;次全切除2例,占4%。面神经解剖保留32例,面神经解剖保留率达100%,其中H.B分级Ⅰ级8例,H.B分级Ⅱ～Ⅲ级24例;功能良好以上保留率为100%。面神经位于前下位置16例,居中6例,前上10例。内听道处理时术中颈静脉球高位4例,磨除内听道时轮廓化4例,出血2例。无术后死亡患者。结论熟练掌握内听道解剖和显微磨钻技术,充分打开内听道后壁,结合术中电生理监测和显微外科技术,可提高听神经瘤的全切除率和面神经功能保留级别。
Objective To investigate the microsurgical treatment of auditory neuroma of the auditory canal and improve the total resection rate of the tumor and facial nerve function retention rate. Clinical data of 32 patients were analyzed retrospectively by listening to the channel after suboccipital approach sigmoid sinus surgery microsurgical acoustic neuroma, after Preoperative CT thin posterior fossa petrous bone scans, intraoperative use of grinding drill (Medtronic) or grinding bone knife (SONOPET company) will be the internal auditory canal mill open, the back wall try to wear open when worn out, surgery underwent neurological electrophysiological monitoring of surface, internal surgical techniques internal auditory canal tumors treated were analyzed . Results The total excision of acoustic neuroma in 30 cases, the total resection rate was 96%; subtotal resection in 2 cases, 4%. Facial nerve anatomy retained 32 cases, the facial nerve anatomy retention rate of 100%, including H.B grade Ⅰ 8 cases, H.B grade Ⅱ ~ Ⅲ 24 cases; function well above the retention rate of 100%. Facial nerve located in the anterior and posterior position in 16 cases, 6 cases in the center, the top 10 cases. Intra-canal treatment of intraoperative jugular bulb high in 4 cases, removal of the internal auditory canal contours in 4 cases, 2 cases of bleeding. No postoperative death patients. Conclusions skilled in the master auditory canal anatomy and microscopic burr technology, fully open the rear wall of the inner auditory canal, combined with intraoperative electrophysiological monitoring and microsurgical techniques, can improve their listening and total removal of the neuroma and facial nerve function preservation levels.