大型听神经瘤手术中面神经的保护研究

摘要

To explore the techniques and methods of facial nerve function preservation during microsurgery resection of large acoustic neuromas.Methods The clinical data of 48 patients with large acoustic neuromas treated microsurgically by suboccipital retrosigrnoid transmeatus approach under neurophysiological monitoring assistance in the First Affiliated Hospital of Xiamen University from March 2011 to February 2018 were analyzed retrospectively.The postoperative effects and the facial nerve function were observed and followed up.Results Total resection was achieved in 31patients(64.6%), subtotal in 11(22.9%) and partial in 6(12.5%). Facial nerve anatomical preserved were achieved in all patients.One week after tumor resection , the functional valuation of facial nerve according to postoperative House-Brackmann scale showed 20 patients(41.67%) in grades Ⅰ-Ⅱ, 27 patients (56.25%) in grades Ⅲ-Ⅳ, and 1 patient (2.08%) in grades Ⅳ-Ⅵ.Three months after tumor resection, the functional valuation of facial nerve showed 21 patients(43.75%) in grades Ⅰ-Ⅱ, 27 patients(56.25%) in grades Ⅲ-Ⅳ. Long-term facial nerve outcome depended on the size of the tumor.The increase of tumor size indicated worse prognosis of postoperative facial nerve function ( all P ＜0.05 ).Conclusions Meticulous microsurgical operation and consummate neurophysiological monitoring assistance are of great value for intraoperative facial nerve preservation.Preoperative tumor size can be used as a predictor of postoperative facial nerve function prognosis.%目的 探讨大型听神经瘤手术中面神经保护的技术及方法.方法 回顾性分析厦门大学附属第一医院神经外科2011年3月—2018年2月,行枕下乙状窦后入路显微手术的48例大型听神经瘤患者的临床资料.对患者的手术效果、术后面神经功能进行观察和随访.结果 本组患者中,肿瘤全切者31 例(64.6%),次全切11例(22.9%),部分切除6例(12.5%).术中面神经均获得解剖保留,术后1周面神经功能B-H分级Ⅰ-Ⅱ级者20例(41.67%)、Ⅲ-Ⅳ级27例(56.25%)、Ⅴ-Ⅵ级1例(2.08%);术后3个月时面神经功能B-H分级Ⅰ-Ⅱ级者21例(43.75%)、Ⅲ-Ⅳ级27例(56.25%),无Ⅴ-Ⅵ级者.随着患者肿瘤直径的增大,其术后面神经H-B分级越高,功能预后越差(均P＜0.05).结论 精细的显微手术操作、完善的神经电生理监测对术中面神经保护具有重要价值;术前肿瘤体积可作为术后面神经功能预后的预测指标.