目的总结术中神经导航应用于听神经瘤的经验,探讨面听神经保留的显微外科技巧,以提高肿瘤的全切率和面听神经的保护率.方法回顾性分析应用术中神经导航技术经枕下乙状窦后-内听道入路显微外科手术治疗的31例听神经瘤.术中神经导航定位静脉窦,引导内听道后壁磨除.27例术中行脑干诱发电位监测.结果肿瘤全切31例,全切除率为100%.术中面神经解剖保留29例,面神经解剖保留率为93.6%.肿瘤切除3个月后复查,面神经功能Ⅰ~Ⅱ级27例(87.1%),Ⅲ~Ⅳ级4例(12.9%).解剖未能保留的2例,术中均行面神经端-端吻合.无手术相关死亡病例.结论神经导航的应用有助于提高听神经瘤切除的安全性和手术疗效.熟练掌握显微手术技巧、术中神经导航和面神经电生理监测的应用是提高肿瘤全切除、面神经解剖和功能保护率的关键.%Objective To report authors’experience in surgical removal of acoustic neuroma with a micro⁃scope-based stereotactic navigational system and in techniques for facial nerve preservation. Methods Data from 31 pa⁃tients with acoustic neuromas who received microsurgical tumor resection between January 2006 and December 2012 via a suboccipital retrosigmoid transmeatus approach with stereotactic navigation assistance were analyzed retrospectively,. Ste⁃reotactic navigation was used to locate the sigmoid sinus and transverse sinus and during removal of the posterior wall of the internal auditory meatus (IAM) for best operational approach.Intraoperative brain stem evoked potentials were performed in 27 cases. Results Total tumor resection was achieved in all 31 cases ( 100%). Facial nerve was anatomically preserved in 29 cases (93.6%). Intracranial end to end anastomosis of the facial nerve was performed in the rest two cases. Facial nerve function was GradeⅠorⅡ) in 27 patients (87.1%) at three months after surgery,Ⅲ-Ⅳin 4 cases (12.9%). No pa⁃tient died in this series. Conclusions Stereotactic navigation can be helpful in improving surgical treatment outcomes in acoustic neuroma. Appropriate surgical skills as well as a combination of intraoperative stereotactic navigation and facial nerve monitoring are the key to improving total tumor resection rate and preserving the facial nerve and its function.
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