中华耳科学杂志
中華耳科學雜誌
중화이과학잡지
CHINESE JOURNAL OF OTOLOGY
2013年
1期
42-48
,共7页
陈立华%徐如祥%魏群%李运军%李文德%赵浩%高进宝%张鹏飞%于斌
陳立華%徐如祥%魏群%李運軍%李文德%趙浩%高進寶%張鵬飛%于斌
진립화%서여상%위군%리운군%리문덕%조호%고진보%장붕비%우빈
听神经瘤%面神经%神经导航%神经监测%显微外科技术
聽神經瘤%麵神經%神經導航%神經鑑測%顯微外科技術
은신경류%면신경%신경도항%신경감측%현미외과기술
Acoustic neuroma%Facial nerve%Neuronavigation%Electrophysiologic monitoring%Microsurgical technique
目的总结术中神经导航应用于听神经瘤的经验,探讨面听神经保留的显微外科技巧,以提高肿瘤的全切率和面听神经的保护率.方法回顾性分析应用术中神经导航技术经枕下乙状窦后-内听道入路显微外科手术治疗的31例听神经瘤.术中神经导航定位静脉窦,引导内听道后壁磨除.27例术中行脑干诱发电位监测.结果肿瘤全切31例,全切除率为100%.术中面神经解剖保留29例,面神经解剖保留率为93.6%.肿瘤切除3个月后复查,面神经功能Ⅰ~Ⅱ级27例(87.1%),Ⅲ~Ⅳ级4例(12.9%).解剖未能保留的2例,术中均行面神经端-端吻合.无手术相关死亡病例.结论神经导航的应用有助于提高听神经瘤切除的安全性和手术疗效.熟练掌握显微手术技巧、术中神经导航和面神经电生理监测的应用是提高肿瘤全切除、面神经解剖和功能保护率的关键.
目的總結術中神經導航應用于聽神經瘤的經驗,探討麵聽神經保留的顯微外科技巧,以提高腫瘤的全切率和麵聽神經的保護率.方法迴顧性分析應用術中神經導航技術經枕下乙狀竇後-內聽道入路顯微外科手術治療的31例聽神經瘤.術中神經導航定位靜脈竇,引導內聽道後壁磨除.27例術中行腦榦誘髮電位鑑測.結果腫瘤全切31例,全切除率為100%.術中麵神經解剖保留29例,麵神經解剖保留率為93.6%.腫瘤切除3箇月後複查,麵神經功能Ⅰ~Ⅱ級27例(87.1%),Ⅲ~Ⅳ級4例(12.9%).解剖未能保留的2例,術中均行麵神經耑-耑吻閤.無手術相關死亡病例.結論神經導航的應用有助于提高聽神經瘤切除的安全性和手術療效.熟練掌握顯微手術技巧、術中神經導航和麵神經電生理鑑測的應用是提高腫瘤全切除、麵神經解剖和功能保護率的關鍵.
목적총결술중신경도항응용우은신경류적경험,탐토면은신경보류적현미외과기교,이제고종류적전절솔화면은신경적보호솔.방법회고성분석응용술중신경도항기술경침하을상두후-내은도입로현미외과수술치료적31례은신경류.술중신경도항정위정맥두,인도내은도후벽마제.27례술중행뇌간유발전위감측.결과종류전절31례,전절제솔위100%.술중면신경해부보류29례,면신경해부보류솔위93.6%.종류절제3개월후복사,면신경공능Ⅰ~Ⅱ급27례(87.1%),Ⅲ~Ⅳ급4례(12.9%).해부미능보류적2례,술중균행면신경단-단문합.무수술상관사망병례.결론신경도항적응용유조우제고은신경류절제적안전성화수술료효.숙련장악현미수술기교、술중신경도항화면신경전생리감측적응용시제고종류전절제、면신경해부화공능보호솔적관건.
Objective To report authors’experience in surgical removal of acoustic neuroma with a micro?scope-based stereotactic navigational system and in techniques for facial nerve preservation. Methods Data from 31 pa?tients with acoustic neuromas who received microsurgical tumor resection between January 2006 and December 2012 via a suboccipital retrosigmoid transmeatus approach with stereotactic navigation assistance were analyzed retrospectively,. Ste?reotactic navigation was used to locate the sigmoid sinus and transverse sinus and during removal of the posterior wall of the internal auditory meatus (IAM) for best operational approach.Intraoperative brain stem evoked potentials were performed in 27 cases. Results Total tumor resection was achieved in all 31 cases ( 100%). Facial nerve was anatomically preserved in 29 cases (93.6%). Intracranial end to end anastomosis of the facial nerve was performed in the rest two cases. Facial nerve function was GradeⅠorⅡ) in 27 patients (87.1%) at three months after surgery,Ⅲ-Ⅳin 4 cases (12.9%). No pa?tient died in this series. Conclusions Stereotactic navigation can be helpful in improving surgical treatment outcomes in acoustic neuroma. Appropriate surgical skills as well as a combination of intraoperative stereotactic navigation and facial nerve monitoring are the key to improving total tumor resection rate and preserving the facial nerve and its function.