摘要
目的探讨经枕下乙状窦后入路切除听神经瘤的手术策略与术后面神经功能的影响因素。方法回顾性分析120例听神经瘤病例资料。均采用枕下乙状窦后入路切除肿瘤,术中全程神经电生理监测。采用House-Brackmann面神经功能分级(H-B分级)评估术后面神经功能。结果面神经解剖保留115例(95.8%)。出院时面神经功能完好(H-B分级Ⅰ级)28例(23.3%),良好(H-B分级Ⅱ~Ⅲ级)47例(39.2%),较差(H-B分级Ⅳ~Ⅵ级)45例(37.5%);术后6个月面神经功能完好68例(56.7%),良好28例(23.3%),较差24例(20%)。Logistic回归分析显示:肿瘤大小、肿瘤囊变和瘤周水肿是影响面神经功能恢复的独立危险因素(均P<0.05)。结论采用枕下乙状窦后入路,显微外科技术结合术中神经电生理监测,可安全、有效切除听神经瘤。肿瘤瘤体大、肿瘤囊变和瘤周水肿的病例,术后面神经功能恢复不佳的风险增大。
Objective To explore the surgical strategy for acoustic neuroma via suboccipital retrosigmoid approach and the factors influencing postoperative facial nerve function.Methods Clinical data of 120 patients with acoustic neuroma were analyzed retrospectively.All the tumors were resected via suboccipital retrosigmoid approach and neuro-electrophysiological monitoring was performed throughout the operation.Facial nerve function was evaluated by House-Brackmann(H-B)grade.Results Facial nerve was anatomically preserved in 115 cases(95.8%).At the time of discharge,facial nerve function was intact(H-B gradeⅠ)in 28 cases(23.3%),good(H-B gradeⅡ-Ⅲ)in 47(39.2%)and poor(H-B gradeⅣ-Ⅵ)in 45(37.5%).At 6 months after the operation,the facial nerve function was intact in 68 cases(56.7%),good in 28(23.3%)and poor in 24(20%).Logistic regression analysis showed that tumor size,tumor cystic degeneration and peritumoral edema were independent risk factors affecting facial nerve function recovery(all P<0.05).Conclusions The suboccipital retrosigmoid approach,combined with intraoperative electrophysiological monitoring and microsurgical technique,can safely and effectively remove acoustic neuroma.Large tumor,tumor cystic degeneration and peritumoral edema may lead to a higher risk of poor recovery of facial nerve function after surgery.
作者
陶晓刚
魏新亭
薛亚轲
陈若琨
杜伟
杨凤东
翟一轩
魏若伦
Tao Xiaogang;Wei Xinting;Xue Yake;Chen Ruokun;Du Wei;Yang Fengdong;Zhai Yixuan;Wei Ruolun(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)
出处
《中国微侵袭神经外科杂志》
CAS
2020年第2期49-52,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
河南省高等学校重点科研项目计划(编号:19A320075).
关键词
神经瘤
听
面神经功能
入路
枕下乙状窦后
影响因素
手术策略
neuroma,acoustic
facial nerve function
approach,suboccipital retrosigmoid
influencing factors
treatment strategies
