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入路25例,颞下入路2例;术中使用内窥镜辅助切除肿瘤10例。结果27例再手术病人中肿瘤全切除21例,次全切除4例,大部分切除2例。无死亡病例。12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,1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,15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。
Objective To explore the curative effect of microsurgery on recurrent acoustic neuromas. Methods The clinical data of 27 patients of recurrent acoustic neuromas undergoing microsurgery in our department was analyzed retrospectively. Of 27 patients with recurrent acoustic neuromas, 25 underwent microsurgery through the suboccipito-retrosigmoid approach and 2 through the subtemporal approach. Neuroendoscope-assisted microsurgery was performed in 10 patients with recurrent acoustic neuromas. Results In all the patients, the totally resection of the tumors was achieved in 21 and subtotalresection in 4, and partial resection in 2. The facial nerve was anatomically preserved in 12 of 16 patients who did not have facial palsy after the first operation. Two patients had cerebrospinal fluid （CSF） leakage from the wound and 1 CSF otorrhea. According to the Glasgow Outcome Scale, 15 patients returned normal life, 8 could takecare of themselves and 4 needed another person＇s help to life. No patients died. Conclusions Although the recurrent tumors often adhere to the surrounding facial nerves and brainstems, the good outcomes can be achieved by microsurgery in most patients with recurrent acoustic neuromas. Regular neurological-image examination after the first surgery is the important helpful to early diagnosis and treatment in the patients with acoustic neuromas.
出处
《中国临床神经外科杂志》
2008年第4期196-198,共3页
Chinese Journal of Clinical Neurosurgery
关键词
听神经鞘瘤
复发
显微手术
Acoustic neuroma
Recurrence
Microsurgery
