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中华脑科疾病与康复杂志(电子版) ›› 2019, Vol. 09 ›› Issue (01) : 36 -38. doi: 10.3877/cma.j.issn.2095-123X.2019.01.008

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短篇论著

大型听神经瘤显微手术治疗
吕学明1,(), 卢培刚1, 初晨宇1, 袁绍纪1, 吕福林1   
  1. 1. 250031 济南,解放军九六〇医院神经外科
  • 收稿日期:2019-04-03 出版日期:2019-02-15
  • 通信作者: 吕学明

Microsurgery for large vestibular schwannomas

Xueming Lyu1,(), Peigang Lu1, Chenyu Chu1, Shaoji Yuan1, Fulin Lyu1   

  1. 1. Department of Neurosurgery, 960 Hospital of PLA, Ji’nan 250031, China
  • Received:2019-04-03 Published:2019-02-15
  • Corresponding author: Xueming Lyu
  • About author:
    Corresponding author: Lyu Xueming, Email:
引用本文:

吕学明, 卢培刚, 初晨宇, 袁绍纪, 吕福林. 大型听神经瘤显微手术治疗[J]. 中华脑科疾病与康复杂志(电子版), 2019, 09(01): 36-38.

Xueming Lyu, Peigang Lu, Chenyu Chu, Shaoji Yuan, Fulin Lyu. Microsurgery for large vestibular schwannomas[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2019, 09(01): 36-38.

目的

探讨大型听神经瘤的显微手术经验。

方法

回顾性分析解放军九六〇医院神经外科自2002年1月至2015年12月收治的47例大型听神经瘤患者,均行枕下乙状窦后入路显微外科切除术,采用术后House-Brackman面神经功能分级评价面神经功能并观察术后并发症。

结果

肿瘤全切除者47例,面神经解剖保留者45例。术后House-Brackman面神经功能分级Ⅰ~Ⅱ级27例,Ⅲ~Ⅳ级17例,V级3例。术后38例患者恢复良好,8例出现术后不良反应,1例死亡。

结论

采用显微外科手术技术可以切除大型听神经瘤并获得面神经解剖的保护,临床疗效良好。

Objective

To explore the microsurgical experience of large vestibular schwannomas.

Methods

A retrospective analysis was made of 47 cases of large vestibular schwannomas treated in Department of Neurosurgery, 960 Hospital of PLA from January 2002 to December 2015. All of them underwent microsurgical resection via retrosigmoid suboccipital approach. Facial nerve function was evaluated by House-Brackman functional grading after operation and complications were observed.

Results

Total resection of tumors was performed in 47 cases and facial nerve was preserved in 45 cases. After operation, House-Brackman facial nerve functional grade Ⅰ-Ⅱ in 27 cases, Ⅲ-Ⅳ in 17 cases and V in 3 cases. After operation, 38 patients recovered well, 8 patients had adverse reactions and 1 patient died.

Conclusion

Using microsurgical technique, large vestibular schwannomas can be removed and facial nerve anatomy can be protected, and the clinical effect is good.

图1 大型听神经瘤患者术前术后影像图
[1]
Harati A, Scheufler KM, Schultheiss R, et al. Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression[J]. Surg Neurol Int, 2017, 8: 45.
[2]
Nair S, Baldawa SS, Gopalakrishnan CV, et al. Surgical outcome in cystic vestibular schwannomas[J]. Asian J Neurosurg, 2016, 11(3): 219-225.
[3]
王鹏程,赵建农,黄垂学,等.大型听神经瘤的显微手术治疗[J].中国微侵袭神经外科杂志, 2010, 15(6): 265-266.
[4]
陈立华,徐如祥,李运军,等.微创手术治疗听神经瘤的研究进展[J].中华神经创伤外科电子杂志, 2018, 4(4): 238-242.
[5]
陈立华,徐如祥,李文德,等.经乙状窦后-内听道入路微创手术治疗听神经瘤[J].中华神经创伤外科电子杂志, 2018, 4(3): 132-138.
[6]
Chiluwal AK, Rothman A, Svrakic M, et al. Surgical outcome in smaller symptomatic vestibular schwannomas. Is there a role for surgery?[J]. Acta Neurochir (Wien), 2018, 160(11): 2263-2275.
[7]
Patni AH, Kartush JM. Staged resection of large acoustic neuromas. [J]. Otolaryngol Head Neck Surg, 2005, 132(1): 11-19.
[8]
Rhoton AL Jr. The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach[J]. Neurosurgery, 2000, 47(3 Suppl): S93-S129.
[9]
Wanibuchi M, Fukushima T, McElveen JT Jr, et al. Hearing preservation in surgery for large vestibular schwannomas[J]. J Neurosurg, 2009, 111(4): 845-854.
[10]
Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections[J]. Neurosurgery, 1997, 40(2): 248-260.
[11]
Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas[J]. J Neurosurg, 2010, 112(4): 860-867.
[12]
Liu SW, Jiang W, Zhang HQ, et al. Intraoperative neuromonitoring for removal of large vestibular schwannoma: Facial nerve outcome and predictive factors[J]. Clin Neurol Neurosurg, 2015, 133: 83-89.
[13]
Yoshino M, Kin T, Ito A, et al. Combined use of diffusion tensor tractography and multifused contrast-enhanced FIESTA for predicting facial and cochlear nerve positions in relation to vestibular schwannoma[J]. J Neurosurg, 2015, 123(6): 1480-1488.
[14]
Choi KS, Kim MS, Kwon HG, et al. Preoperative identification of facial nerve in vestibular schwannomas surgery using diffusion tensor tractography[J]. J Korean Neurosurg Soc, 2014, 56(1): 11-15.
[15]
Karkas A, Lamblin E, Meyer M, et al. Trigeminal nerve deficit in large and compressive acoustic neuromas and its correlation with MRI findings[J]. Otolaryngol Head Neck Surg, 2014, 151(4): 675-680.
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