听神经瘤的显微外科切除及治疗策略探讨

摘要

Objective To study operative nuances in the microsurgical resection of vestibular schwannomas and preservation of facial and cochlear functions and to discuss treatment strategies in the management of vestibular schwanno⁃mas. Methods Two hundred and twenty-one patients with unilateral vestibular schwannomas treated between October 2008 and April 2012 were included. One hundred and eighty-three cases (82.8%) had large vestibular schwannmas. The sub-oc⁃cipital retrosigmoid approach was selected and intraoperative monitoring of the facial and trigeminal nerves and auditory brainstem responses (ABR) was used in all cases. Results Total or near total tumor resection was achieved in 199 cases (90%), and sub-total resection in 22 cases (10%). The anatomical integrity of the facial nerve was preserved in 91%of the cases. At last follow-up, 82.8%of all patients had excellent or good facial nerve function, and 33%of patients with good preoperative hearing levels had hearing preservation postoperatively. Conclusion Large vestibular schwannomas can be suc⁃cessfully treated with microsurgical resection. Treatment strategies should be individualized. The purpose of treatment should focus on patients’s quality of life.%　　目的探讨听神经瘤显微外科切除的手术技巧和术中面听神经保护要点及治疗策略的选择.方法分析2008年10月至2012年4月期间221例单侧听神经瘤病例，其中大型听神经瘤(直径≥3cm)183例(占82.8%)，采用枕下乙状窦后入路，术中全程行面、三叉神经/和听性脑干反应监测.结果肿瘤全切及近全切除共199例(占90%)，次全切除共22例(占10%).面神经解剖保留201例(占91%)，功能保留183例(占82.8%).耳蜗神经功能保留33%.结论显微手术切除是治疗大型听神经瘤的主要方法，听神经瘤的治疗策略应该根据具体情况个性化选择，目的是患者长期高质量的生存.