手术治疗复发听神经瘤的临床分析.docVIP

手术治疗复发听神经瘤的临床分析 一 196_ChinJClinNeurosurg,Apr2008,Vol13,No4 .论着. 手术治疗复发听神经瘤的临床分析 于加省雷霆陈劲草陈坚杨正明王胜李龄 【摘要】目的研究复发听神经瘤的手术方法和疗效.方法回顾性分析27例复发听神经瘤病人的临床诊治资料.手术方法 采用原手术切口枕下乙状窦后人路25例,颞下人路2例;术中使用内窥镜辅助切除肿瘤l0例.结果27例再手术病人中肿瘤全 切除2l例,次全切除4例,大部分切除2例.无死亡病例.l2例在手术后面神经得到解剖保留.有2例手术后出现伤口脑脊液 漏,l例出现脑脊液耳漏.经腰穿置管引流等保守治疗后好转.2例于半年内复诊时仍伴有明显脑积水,行分流手术后症状改善. 术后按GOS评估,l5例患者正常生活和工作,8例可做轻量工作或生活能自理,4例需要他人照顾.结论虽然复发听神经瘤与面 听神经,脑干等结构有不同程度的粘连.但大多数患者经显微手术治疗可取得良好的效果. 【关键词】听神经鞘瘤;复发;显微手术 【文章编号】1009—153X(2008)04—0196—03【文献标识码】A【中图分类号】R73941;R651.1l MicrosurgeryforRecurrentAcousticNeuromas YUJ一sheng,LEITing,CHENJin—COD,et.DepartmentofNeurosurgery,ronviHospital,ronviMedamp;dSchool,Huazhong Unwe~ofSciencesandTechnology,WuhanHubei430O30,China 【Abstract】ObjectiveToexplorethecurativeeffectofmicrosurgeryonrecurrentacousticneuromas.MethodsTheclinicaldata of27patientsofrecurrentacousticneuromasundergoingmicrosurgeryinourdepartmentwasanalyzedretrospectively.Of27patients witIlrecurrentacousticneuromas.25underwentmicrosurgerythroughthesuboccipito-retrosigmoidapproachand2throughthe subtemporalapproach.Neuroendoscope-assistedmicrosurgerywasperformedin10patientswithrecurremacousticneuromas.Results Inallthepatients,thetotallyresectionofthetumorsWasachievedin21andsubtota1.resecti0nin4,andpartialresectionin2.The facialnervewasanatomicallypreservedin12of16patientswhodidnothavefacialpalsyafterthefirstoperation.Twopatientshad cerebrospinalfluid(CSleakagefromthewoundandlCSFotorrhea.AccordingtotheGlasgowOutcomeScale,15patientsreturned normallife,8couldtake, careofthemselvesand4neededanotherpersonShelptolife.Nopatientsdied.ConclusionsAlthoughthe recurrenttumorsoftenadheretothesurroundingfacialnervesandbrainstems,thegoodoutcomescanbeachievedbymicrosurgeryin mostpatientswithrecurrentacousticneuromas.Regularneurological-imageexaminationafterthefirstsurgeryistheimportanthelpful toearlydiagnosisandtreatmentinthepatientswithacousticneuromas. 【KeyWords】Acousticneuroma;Recurrence;Microsurgery 近年来.随着CT,MRI现代影像技术的提高,使 得较小的或位于内听道内的听神经瘤能够早期被发 现并得以治