中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2011年
8期
822-824
,共3页
吴喜跃%江常震%吴赞艺%郑树法%王晨阳%康德智
吳喜躍%江常震%吳讚藝%鄭樹法%王晨暘%康德智
오희약%강상진%오찬예%정수법%왕신양%강덕지
听神经瘤%显微外科手术%面神经
聽神經瘤%顯微外科手術%麵神經
은신경류%현미외과수술%면신경
Acoustic neuroma%Microsurgery%Facial nerve
目的 探讨听神经瘤的显微外科手术技巧及保留面神经的技术。 方法 福建医科大学附属第一医院神经外科自2002年8月至2010年12月经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤患者168例，术中在面肌肌电图监测下采取囊内切除与囊壁切除交替进行、双向会合、锐性分离面神经等技术切除肿瘤，并回顾性分析显微手术的技巧和疗效。 结果 肿瘤全切149例(88.69％)，部分切除19例(11.31％)；面神经解剖学保留146例(86.9％)；死亡2例(1.19％)。术后6个月按House Blackmann标准评估面神经功能：Ⅰ、Ⅱ级91例(54.16％)，Ⅲ、Ⅳ级52例(30.95％)，Ⅴ、Ⅵ级25例(14.89％)。 结论 经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤安全有效；利用术中面肌肌电图监测可以提高面神经解剖保留率；熟练掌握显微手术技巧是全切肿瘤、解剖保留面神经的关键。
目的 探討聽神經瘤的顯微外科手術技巧及保留麵神經的技術。 方法 福建醫科大學附屬第一醫院神經外科自2002年8月至2010年12月經枕下乙狀竇後（骨瓣成型、鎖孔）入路顯微手術治療聽神經瘤患者168例，術中在麵肌肌電圖鑑測下採取囊內切除與囊壁切除交替進行、雙嚮會閤、銳性分離麵神經等技術切除腫瘤，併迴顧性分析顯微手術的技巧和療效。 結果 腫瘤全切149例(88.69％)，部分切除19例(11.31％)；麵神經解剖學保留146例(86.9％)；死亡2例(1.19％)。術後6箇月按House Blackmann標準評估麵神經功能：Ⅰ、Ⅱ級91例(54.16％)，Ⅲ、Ⅳ級52例(30.95％)，Ⅴ、Ⅵ級25例(14.89％)。 結論 經枕下乙狀竇後（骨瓣成型、鎖孔）入路顯微手術治療聽神經瘤安全有效；利用術中麵肌肌電圖鑑測可以提高麵神經解剖保留率；熟練掌握顯微手術技巧是全切腫瘤、解剖保留麵神經的關鍵。
목적 탐토은신경류적현미외과수술기교급보류면신경적기술。 방법 복건의과대학부속제일의원신경외과자2002년8월지2010년12월경침하을상두후（골판성형、쇄공）입로현미수술치료은신경류환자168례，술중재면기기전도감측하채취낭내절제여낭벽절제교체진행、쌍향회합、예성분리면신경등기술절제종류，병회고성분석현미수술적기교화료효。 결과 종류전절149례(88.69％)，부분절제19례(11.31％)；면신경해부학보류146례(86.9％)；사망2례(1.19％)。술후6개월안House Blackmann표준평고면신경공능：Ⅰ、Ⅱ급91례(54.16％)，Ⅲ、Ⅳ급52례(30.95％)，Ⅴ、Ⅵ급25례(14.89％)。 결론 경침하을상두후（골판성형、쇄공）입로현미수술치료은신경류안전유효；이용술중면기기전도감측가이제고면신경해부보류솔；숙련장악현미수술기교시전절종류、해부보류면신경적관건。
Objective To discuss the microsurgical skills of management of acoustic neuroma and the protection of facial nerve. Methods One hundred and sixty-eight patients with acoustic neuroma, admitted to our hospital from August 2002 to December 2010, received microsurgery through suboccipital retrosigmoid approach. Under intraoperative electromyography (EMG) monitoring, the facial nerve was separated sharply from both sides, and the tumors were removed by alternate intracapsular excision and capsule wall excision. The microsurgical skill and the method of protection of facial nerve were evaluated retrospectively. Results Total resection was performed in 149 cases (88.69％), partial resection in 19 cases (11.31％). Facial nerve was protected in 146 cases (86.9％) during the operation. Two patients were dead shortly after the surgery. The facial nerve functions were evaluated 6 months after the surgery: 91 (54.26％) belonged to grade Ⅰ and grade Ⅱ, and 52 (30.95％) belonged to grade Ⅲ and grade Ⅳ, while 52 (14.89％) belonged to grade Ⅴ and grade Ⅵ according to House-Brackmann grade. Conclusion The microsurgical removal of acoustic neuroma through suboccipital retrosigmoid approach is safe and effective. The intraoperative electromyography monitoring could improve the reservation rate of facial nerve. Skilled microsurgical technique is the key to the total removal of acoustic minor and the protection of facial nerve.
