CAJ | 학술논문

目的探讨神经内镜辅助及显微镜手术经乙状窦后入路治疗小型听神经瘤的方法及效果.方法对山西省人民医院2008至2013年入住的20例听神经瘤患者行神经内镜辅助及22例行显微镜锁孔手术切除,术中应用面神经监测及30°神经内镜辅助及显微镜.内镜辅助组用神经内镜多方位观察面神经及内听道情况,显微镜组直视下手术.对比两种方法对面神经的损伤及内听道磨除程度的影响.结果 20例听神经瘤经神经内镜辅助手术均全切除并面神经保留.术后面神经功能Ⅰ级6例,Ⅱ级10例,Ⅲ级4例;16例内听道未磨除,4例仅磨除2～3 mm.22例经显微镜切除的听神经瘤,术后面神经功能Ⅰ级5例,Ⅱ6级例,Ⅲ级8例,Ⅲ～Ⅳ3例;10例内听道未磨除,12例至少磨除3 mm;两种方法均无脑脊液漏等并发症.结论神经内镜局部放大、良好照明及其广角和成角的特点在治疗听神经瘤过程中能有效弥补显微镜的不足,从而减轻面神经的损伤及减少内听道的磨除,提高手术疗效.
목적 탐토신경내경보조급현미경수술경을상두후입로치료소형은신경류적방법급효과.방법 대산서성인민의원2008지2013년입주적20례은신경류환자행신경내경보조급22례행현미경쇄공수술절제,술중응용면신경감측급30°신경내경보조급현미경.내경보조조용신경내경다방위관찰면신경급내은도정황,현미경조직시하수술.대비량충방법대면신경적손상급내은도마제정도적영향.결과 20례은신경류경신경내경보조수술균전절제병면신경보류.술후면신경공능Ⅰ급6례,Ⅱ급10례,Ⅲ급4례;16례내은도미마제,4례부마제2～3 mm.22례경현미경절제적은신경류,술후면신경공능Ⅰ급5례,Ⅱ6급례,Ⅲ급8례,Ⅲ～Ⅳ3례;10례내은도미마제,12례지소마제3 mm;량충방법균무뇌척액루등병발증.결론 신경내경국부방대、량호조명급기엄각화성각적특점재치료은신경류과정중능유효미보현미경적불족,종이감경면신경적손상급감소내은도적마제,제고수술료효.
Objective To explore the outcomes of surgery for the treatment of small acoustic neuroma by the neuroendoscope-assisted microsurgery and microscope.Methods From 2008 to 2013,42 patients with small acoustic neuroma underwent neuroendoscope-assisted microsurgery (n =20) and microscopic tumoural resection (n =22).Neurophysiological monitoring,30-degree rigid neuroendoscope and microscope were employed intra-operatively.For the endoscope group,facial nerve and inner acoustic meatus could be visualized distinctly in each aspect,as for the microscope group,microscopic operation could be accomplished directly.The damage extents of facial nerve and inner acoustic meatus were compared between two groups.Results Total removal of acoustic neuroma and conservation of facial nerve were achieved in all patients.For the neuroendoscope-assisted group,the postoperative facial functions were Grade Ⅰ (n =6),Grade Ⅱ (n =10) and Grade Ⅲ (n =4).Internal acoustic canal was drilled 2-3 mm in 4 patients and no drilling in others.For the microscope group,Grade Ⅰ (n =5),Grade Ⅱ] (n =6),Grade Ⅲ (n =8) and Grade Ⅲ-Ⅳ (n =3).Internal acoustic canal was drilled at least 3 mm in 12 patients and no drilling in others.No complication such as cerebrospinal fluid leakage occurred during the followups.Conclusion Endosocopic operation of acoustic neuroma surgery is superior to microscopic operation in terms of magnification,illumination,wide-angel and angulation.And the former procedure may yield better outcomes through alleviating the damage of facial nerve and decreasing the drilling degree of inner acoustic meatus.