摘要
目的总结经乙状窦后-内听道入路显微外科手术切除内听道脑膜瘤的方法和经验,探讨在保留面、听神经功能的基础上实现肿瘤全切除的技巧。方法回顾性分析首都医科大学宣武医院、中国人民解放军陆军总医院神经外科自1998年1月至2018年12月采用乙状窦后-内听道入路显微外科手术切除、经病理证实的4例内听道脑膜瘤患者的临床资料和疗效,分析其手术要点。结果4例患者的肿瘤均获得全切除,其中1例肿瘤硬膜起源于内听道口的外侧壁(Simpson分级Ⅰ级切除);3例肿瘤起源于内听道内的硬脑膜,硬膜附着延伸至内听道腹侧(Simpson分级Ⅱ级切除)。3例患者的面神经和耳蜗神经均被解剖分离保护,另一例患者仅解剖保留面神经。2例术前听力分级为H2级、H3级的患者,术后听力分级分别为H3级和H4级,另2例术前听力H5级的患者术后听力仍为H5级。3例患者术后Kamofsky功能状态评分(KPS)为90分,1例为70分。无围手术期死亡患者。结论乙状窦后-内听道入路是内听道脑膜瘤显微外科切除术的理想入路。手术应以保护面、听神经为前提,以广泛切除肿瘤为目的,包括肿瘤累及的硬脑膜和骨质,以减少复发的机会,改良内听道开放的宽度是必要的。
Objective To summarize the surgical methods and experiences of intra-auditory meningioma,and discuss the techniques achieving complete resection of intra-auditory meningioma by retrosigmoid transmeatal approach on the basis of function reservation of the facial nerve and auditory nerve.Methods The clinical data of 4 patients with intra-auditory meningioma confirmed by surgery and pathology in Xuanwu Hospital of Capital Medical University and Army General Hospital of People's Liberation Army from January 1998 to December 2018 were retrospectively analyzed.All these 4 patients accepted enlargment of the posterior wall of the internal auditory channel via retrosigmoid transmeatal approach to remove the tumors.The electro-audiogram,surgical records,discharge records and follow-up records were noted.Results Total resection was achieved in all 4 patients;one was derived from the cerebral dura mater of the outside wall of the internal auditory canal,obtaining radical excision(Simpson grading Ⅰ resection);the other three were derived from the cerebral dura mater of the internal auditory canal,and the epidural adhesion extended to the ventral internal auditory canal,only receiving Simpson grading Ⅱ resection.The facial nerve and cochlear nerve in three patients were separated and protected by dissection;while the vestibular nerve and cochlear nerve in the left one patient were not found,and only the facial nerve was dissected and preserved.Two patients with preoperative hearing grading H2 and H3 were able to retain effective hearing after surgery,with postoperative hearing grading H3 and H4,respectively;and the other two patients had postoperative hearing grading H5.Postoperative Kamofsky Perfonnance Scale(KPS)scores were 90 in 3 patients and 70 in one patient.There was no perioperative death.Conclusions Retrosigmoid transmeatal approach is ideal approach for resection of the intra-auditory meningioma.Surgical excision of intra-auditory meningioma should accept the premise of protecting the facial auditory nerve and aim at extensive resection of tumors,including the dura and bone involved by tumors,so as to reduce the chance of recurrence;and it is necessary to open the width of intra-auditory.
作者
陈立华
陈文锦
张洪钿
孙恺
徐如祥
Chen Lihua;Chen Wenjin;Zhang Hongtian;Sun Kai;Xu Ruxiang(Department of Neurosurgery,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2020年第3期229-233,共5页
Chinese Journal of Neuromedicine
关键词
内听道
脑膜瘤
乙状窦后-内听道入路
桥脑小脑角
Intra-auditory
Meningioma
Retrosigmoid transmeatal approach
Cerebello-pontine angle
