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目的总结31例经枕下乙状窦后入路显微手术切除大型听神经瘤的经验及术中保留面听神经的手术操作技巧。方法31例大型听神经瘤(直径≥4 cm)均经CT和MRI扫描诊断,采用枕下乙状窦后入路对大型听神经瘤行显微手术切除,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25例,次全切除6例,无死亡病例。面神经解剖保留25例,术后2周功能保留21例;听神经解剖保留6例,术后2周功能保留2例。结论乙状窦后入路显微镜下切除大型听神经瘤是安全的手术方法,对脑组织结构的创伤小,利于提高肿瘤全切除率并有效保护面神经和听神经的功能。
Objective To summarize the experience of 31 cases of large acoustic neuroma excised by suboccipitally retrosigmoidal microsurgical posterior approach and the operative techniques of preserving facial nerve in operation. Methods 31 cases of large acoustic neuroma (diameter ≥ 4 cm) were diagnosed by CT and MRI scan. The suboccipitated sigmoid sinus posterior approach was used for microsurgical resection of large acoustic neuroma. Facial nerve and auditory nerve were performed before and after operation Functional assessment. Results Totally resected tumor in 25 cases, subtotal resection in 6 cases, no deaths. Facial nerve anatomy retained in 25 cases, 2 weeks after surgery to retain the function of 21 cases; auditory nerve anatomy retained in 6 cases, 2 weeks after the function retained in 2 cases. Conclusions The sigmoid sinus posterior approach microsurgical resection of large acoustic neuroma is a safe surgical method. It has less trauma to the brain tissue structure, which helps to improve the total resection rate and effectively protect the facial nerve and auditory nerve.