CAJ | 학술논문

目的探讨听神经瘤手术中面、听神经的保护方法及手术技巧.方法 76例首发听神经瘤患者,行枕下-乙状窦后入路显微手术切除,术中行神经电生理监测及药物保护(尼莫地平),分别于术前、术后1周及1年行面神经HB功能分级评估及听力评估.结果 76例患者中,肿瘤全切71例(93%),面神经解剖保留74例(97%),听神经解剖保留16例(21%).术后1周面神经功能评估,Ⅰ级25例,Ⅱ级32例,Ⅲ级11例,Ⅳ级4例,Ⅴ级2例,Ⅵ级2例.术后1年面神经功能评估,Ⅰ级37例,Ⅱ级24例,Ⅲ级9例,Ⅳ级3例,Ⅴ级1例,Ⅵ级2例.术后1年时听力保留者16例,占21%.结论听神经瘤手术中进行面神经电生理监测、药物治疗及娴熟的显微外科技巧是面、听神经功能保护的关键.
목적 탐토은신경류수술중면、은신경적보호방법급수술기교.방법 76례수발은신경류환자,행침하-을상두후입로현미수술절제,술중행신경전생리감측급약물보호(니막지평),분별우술전、술후1주급1년행면신경HB공능분급평고급은력평고.결과 76례환자중,종류전절71례(93%),면신경해부보류74례(97%),은신경해부보류16례(21%).술후1주면신경공능평고,Ⅰ급25례,Ⅱ급32례,Ⅲ급11례,Ⅳ급4례,Ⅴ급2례,Ⅵ급2례.술후1년면신경공능평고,Ⅰ급37례,Ⅱ급24례,Ⅲ급9례,Ⅳ급3례,Ⅴ급1례,Ⅵ급2례.술후1년시은력보류자16례,점21%.결론 은신경류수술중진행면신경전생리감측、약물치료급한숙적현미외과기교시면、은신경공능보호적관건.
Objective To study the skills of facial nerve and cochlear nerve reservation in acoustic neurinoma surgery. Method 76 patients with acoustic neurinoma were operated via suboccipital retrosigmoid transmeatal approach. Intraoperative electromyographic monitoring,drug treatment( Nimodipine) and microsurgical techniques were used. The facial nerve and cochlear nerve function were evaluated before and after surgery, as well as 1 year after the surgical procedure. Results Total tumor resection was achieved in 71 patients (93% ). Facial nerve was kept anatomicly intact completely in 74(97% ) patients, while the rate of cochlear nerve was 21% (16 patients). One week after surgery,an HB score of Ⅰ was documented in 25 patients,HB Ⅱ in 32.HB Ⅲ in 11 ,HB Ⅳ in 4,HB Ⅴ in 2 and HB Ⅵ in 2 patients. After 1 year,an HB score of Ⅰ was documented in 37 patients,HB Ⅱ in 24,HB Ⅲ in 9,HB Ⅳ in 3 ,HB Ⅴ in 1 and HB Ⅵ in 2 patients. One year after surgery, the hearing function was kept in 16 patients (21% ). Conclusions Effective nerve function monitoring,excellent microsurgical skills and drug treatment are very important for keeping facial nerve and cochlear nerve function in acoustic neurinoma surgery.