经扩大迷路径路显微手术切除大型听神经瘤

摘要

Objective To explore the microsurgery technique and outcome of expanding translabyrinthine ap-proach resection large acoustic neuroma .Methods We have retrospectively studied clinical data and follow -up re-sults of 4 patients of large acoustic neuroma (≥5 cm ,the largest was 8 cm ;3 cases with servere sensorineualt hear-ing loss ,1 case with high frequenoy hearing loss ;1 case with blindness) in our hospital between January 2013 and April 2013 .All patients received expanding translabyrinthine approach microsurgery to resecting the tumors .Post-operative follow -up was 6~10 months .Results The large acoustic neuroma of 4 cases were totally removed via MRI reexamination after operation .Facial nerve in 3 cases were dissection retained ,and 1 case received facial nerve anastomosis .Six months after operatin ,one patient’s facial nerve function recovered from level Ⅲ to level Ⅱ ,the patient underwent facial nerve anastomosis with facial paralysis level Ⅵ recovered to level Ⅳ ,and the vision of pa-tient with blindness completely recovered to normal .Conclusion The expanding translabyrinthine approach can to-tally resect large acoustic neuroma and preserve facial nerve function .%目的：探讨经扩大迷路径路大型听神经瘤切除术的显微手术技巧及效果。方法回顾性分析2013年1～4月收治的4例大型听神经瘤患者的临床资料，所有患者均采用扩大迷路径路显微手术治疗，术中面神经解剖保留3例，1例患者行面神经端端吻合。术后随访6～10个月。结果本组4例大型听神经瘤患者肿瘤直径均≥5 cm ，最大为8 cm ，3例为重度感音神经性聋，1例高频听力下降；伴失明1例。术后复查内听道M RI显示肿瘤均全部切除，术后6个月随访时，2例面神经功能正常，1例患者面神经功能由Ⅲ级恢复到Ⅱ级，1例行面神经吻合的患者面神经功能由Ⅵ级恢复到Ⅳ级，1例伴失明的患者视力完全恢复正常。结论扩大迷路径路显微外科手术可以完全切除大型听神经瘤，并可部分或全部保留面神经功能。