[1]孙守家 赵 凯 王俊文 朱明欣 蒋 伟 杨正明 舒 凯 雷 霆.枕下乙状窦后入路锁孔手术切除听神经瘤[J].中国临床神经外科杂志,2019,(02):65-68.[doi:10.13798/j.issn.1009-153X.2019.02.001]
 SUN Shou-jia,ZHAO Kai,WANG Jun-wen,et al.Retrospective analysis of resecting acoustic neuromas by keyhole surgery via suboccipital retrosigmoid approach[J].,2019,(02):65-68.[doi:10.13798/j.issn.1009-153X.2019.02.001]
点击复制

枕下乙状窦后入路锁孔手术切除听神经瘤()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年02期
页码:
65-68
栏目:
论著
出版日期:
2019-02-20

文章信息/Info

Title:
Retrospective analysis of resecting acoustic neuromas by keyhole surgery via suboccipital retrosigmoid approach
文章编号:
1009-153X(2019)02-0065-04
作者:
孙守家 赵 凯 王俊文 朱明欣 蒋 伟 杨正明 舒 凯 雷 霆
430030 武汉,华中科技大学同济医学院附属同济医院神经外科(孙守家、赵 凯、王俊文、朱明欣、蒋 伟、杨正明、舒 凯、雷 霆);250012 济南,山东大学齐鲁医院神经外科(孙守家)
Author(s):
SUN Shou-jia12 ZHAO Kai1 WANG Jun-wen1 ZHU Ming-xin1 JIANG Wei1 YANG Zheng-ming1 SHU Kai1 LEI Ting1.
1. Department of Neurosurgery, Tongji Hospital, Tongji Medical School, Huazhong University of Sciences and Technology, Wuhan 430030, China; 2. Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
关键词:
听神经瘤枕下乙状窦后入路锁孔手术面神经
Keywords:
Acoustic neuromas Keyhole surgery Suboccipital retrosigmoid approach Neuroprotection Facial nerve
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.02.001
文献标志码:
A
摘要:
目的 探讨枕下乙状窦后入路锁孔手术切除听神经瘤的方法及效果。方法 回顾性分析2016年1月至2018年6月经枕下乙状窦后入路锁孔手术治疗的116例听神经瘤的临床资料,根据术前增强MRI分为中小型听神经瘤组(最大径≤3 cm;83例)和大型听神经瘤组(最大径>3 cm;33例)。结果 中小型听神经瘤组肿瘤全切除率为97.6%(81/83),面神经解剖保留80例(96.4%)。术后1周面神经功能良好(H-B分级Ⅰ~Ⅱ级)59例(71.1%)。大型听神经瘤组肿瘤全切除率87.9%(29/33),面神经解剖保留28例(84.8%),术后1周面神经功能良好18例(54.5%)。结论 对于中小型听神经瘤,采用枕下乙状窦后入路锁孔手术可实现肿瘤完全切除和良好的面神经功能保护。对于大型听神经瘤,在良好体位、充分释放脑脊液、电生理监测等辅助下,采用乙状窦后入路锁孔手术也可实现肿瘤安全满意切除和面神经功能保护。
Abstract:
Objective To summarize the clinical experience in resecting the acoustic neuromas by keyhole surgery via suboccipital retrosigmoid approach. Methods The clinical data of 116 patients with acoustic neuroma, who underwent the keyhole surgery via suboccipital retrosigmoid approach from January, 2016 to June, 2018, were analyzed retrospectively. Results The gross-total resection rate of the neuromas was 97.6% (81/83), the rate of anatomical preservation of the facial nerve was 96.4% (80/83), and the good rate of facial nerve function (H-B grade Ⅰ~Ⅱ) was 71.1% (59/83) after the surgery in 83 patients with the small and medium acoustic neuromas. The gross-total resection rate of the tumors was 87.9% (29/33), The rate of anatomical preservation of the facial nerve was 84.8% (28/33), and the good rate of facial nerve function was 54.5% (18/29) after the surgery in 33 patients with large acoustic neuromas. Conclusions The acoustic neuromas can be totally resected by the keyhole surgery via the suboccipital retrosigmoid approach and there is good facial nerve function after the surgery in the patients with small and medium acoustic neuromas. The safe and total resection of the tumors and good neuroprotection of the facial nerve can be reached by the keyhole surgery via the suboccipital retrosigmoid approach with the aid of the good posture, sufficient release of cerebrospinal fluid and electrophysiological monitoring in the patients with large acoustic neuromas.

参考文献/References:


[1] 兰 静,江普查,曹长军,等. 枕下乙状窦后入路显微手术 切除听神经瘤的临床分析[J]. 中国临床神经外科杂志, 2017,22(9):665-667.
[2] 常书锋,杨 波,郑 鲁,等. 枕下乙状窦后入路锁孔手术 治疗大型听神经瘤31例[J]. 中国临床神经外科杂志, 2018,23(7):494-496.
[3] 李 扬,何强华,杨 华. 枕下乙状窦后锁孔入路手术切 除听神经瘤[J]. 中国临床神经外科杂志,2016,21(10): 603-605.
[4] 戴宇翔,倪红斌. 改良脑脊液释放方法在锁孔枕下乙状窦 后入路切除大型听神经瘤的应用[J]. 中国微侵袭神经外 科杂志,2017,22(11):509-510.
[5] 舒 凯,雷 霆,李 龄. 蛛网膜平面内听神经瘤显微切 除术[J]. 临床外科杂志, 2017,25(9):649-651.
[6] Savardekar A, Nagata T, Kiatsoontorn K, et al. Preservation of labyrinthine structures while drilling the posterior wall of the internal auditory canal in surgery of vestibular schwan- nomas via the retrosigmoid suboccipital approach [J]. World Neurosurg, 2014, 82(3-4): 474-479.
[7] Charalampakis S, Koutsimpelas D, Gouveris H, et al. Post- operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: cur- rent diagnosis and management [J]. Eur Arch Otorhino- laryngol, 2011, 268(5): 653-660.
[8] 张 荣,周良辅,毛 颖. 听神经瘤的锁孔手术治疗[J]. 中国微侵袭神经外科杂志,2005,10(3):100-101.
[9] Santarius T, D’Sousa AR, Zeitoun HM, et al. Audit of head- ache following resection of acoustic neuroma using three different techniques of suboccipital approach [J]. Rev Laryngol Otol Rhinol (Bord), 2000, 121(2): 75-78.
[10] Yamashima T, Lee J H, Tobias S, et al. Surgical procedure "simplified retrosigmoid approach" for C-P angle lesions [J]. J Clin Neurosci, 2004, 11(2): 168-171.
[11] Magnan J, Barbieri M, Mora R, et al. Retrosigmoid approach for small and medium-sized acoustic neuromas [J]. Otol Neurotol, 2002, 23(2): 141-145.
[12] 中国颅底外科多学科协作组. 听神经瘤多学科协作诊疗 中国专家共识[J]. 中华神经外科杂志,2016,32(3):217- 221.
[13] Brennan JW, Rowed DW, Nedzelski JM, et al. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment [J]. J Neurosurg, 2001, 94(2): 217-223.
[14] 陈立华,刘运生,方加胜,等. 听神经瘤枕下乙状窦后锁孔 入路的临床探讨[J]. 中国耳鼻咽喉颅底外科杂志,2002, 8(1):11-14.
[15] 谭国伟,王占祥,郭剑峰,等. 枕下乙状窦后锁孔入路显微 手术切除大型听神经鞘瘤[J]. 中华神经医学杂志, 2010, 9(12):1243-1245.
[16] 林晓风,李昭杰,林志俊,等. 枕下乙状窦后锁孔入路显微 手术切除大型听神经瘤[J]. 中国微侵袭神经外科杂志, 2004,9(9):400-401.
[17] 雷 霆,李 龄. 听神经瘤显微手术面神经损伤的预防 [J]. 中华外科杂志,2008,46(1):58-60.
[18] 孙守家,高 攀,张晓静,等. 超声吸引刀的磨骨功能在听 神经瘤显微手术内听道处理中的应用[J]. 中华神经外科 杂志,2016,32(8):836-839.

相似文献/References:

[1]朱贵东 赵振宇 门学忠 楚德国 孙希炎 李翠玲 于 峰 王锦琰.原发性舌咽神经痛的显微手术治疗(附33例分析)[J].中国临床神经外科杂志,2016,(02):76.[doi:10.13798/j.issn.1009-153X.2016.02.005]
 ZHU Gui-dong,ZHAO Zhen-yu,MEN Xue-zhong,et al.Microneurosurgery for glossopharyngeal neuralgia(report of 33 cases)[J].,2016,(02):76.[doi:10.13798/j.issn.1009-153X.2016.02.005]
[2]陈大瑜 姚国杰 张 戈 李成才 杜 威 韦 可 甘志强 龚 杰.大中型听神经瘤的显微手术治疗及面神经的保护[J].中国临床神经外科杂志,2015,(12):724.[doi:10.13798/j.issn.1009-153X.2015.12.006]
 CHEN Da-yu,YAO Guo-jie,ZHANG Ge,et al.Microsurgical treatment of large and middle acoustic neuromas and intraoperative preservation of facial nerves[J].,2015,(02):724.[doi:10.13798/j.issn.1009-153X.2015.12.006]
[3]王玉峰 郭 庚 万大海 郝解贺.磨除内听道在听神经瘤手术中的意义[J].中国临床神经外科杂志,2015,(08):456.[doi:10.13798/j.issn.1009-153X.2015.08.003]
 WANG Yu-feng,GUO Geng,WAN Da-hai,et al.Value of rubbing off the posterior wall of internal auditory meatus to surgery for acoustic neuromas[J].,2015,(02):456.[doi:10.13798/j.issn.1009-153X.2015.08.003]
[4]耿 飞.枕下乙状窦后入路微血管减压治疗面肌痉挛的并发症及处理[J].中国临床神经外科杂志,2015,(03):168.[doi:10.13798/j.issn.1009-153X.2015.03.014]
[5]李 扬 何强华 杨 华.枕下乙状窦后锁孔入路手术切除听神经瘤[J].中国临床神经外科杂志,2016,(10):603.[doi:10.13798/j.issn.1009-153X.2016.10.011]
 LI Yang,HE Qiang-hua,YANG Hua..Microsurgery via suboccipital retrosigmoid keyhole approach for acoustic neuromas[J].,2016,(02):603.[doi:10.13798/j.issn.1009-153X.2016.10.011]
[6]肖富尹,王向鹏 综述,杨智勇 审校.NF2相关听神经瘤的临床治疗方法[J].中国临床神经外科杂志,2017,(07):520.[doi:10.13798/j.issn.1009-153X.2017.07.029]
[7]罗正祥 刘英亮 章文斌 杨 坤 胡新华 邹元杰 张岩松 阚文武.3D-CT颅骨重建技术在枕下乙状窦后入路开颅术中的应用[J].中国临床神经外科杂志,2017,(09):630.[doi:10.13798/j.issn.1009-153X.2017.09.007]
 LUO Zheng-xiang,LIU Ying-liang,ZHANG Wen-bin,et al.Application of three-dimensional CT cranial bones reconstruction technique to surgery through suboccipital retrosigmoid approach[J].,2017,(02):630.[doi:10.13798/j.issn.1009-153X.2017.09.007]
[8]余海林 李 刚 王晓松.原发性舌咽神经痛的临床特点及手术治疗[J].中国临床神经外科杂志,2018,(04):260.[doi:10.13798/j.issn.1009-153X.2018.04.012]
[9]常书锋 杨 波 郑 鲁 黄晓峰 付战胜 杨万敬 刘 昌 王俊善.枕下乙状窦后入路锁孔手术治疗大型听神经瘤31例[J].中国临床神经外科杂志,2018,(07):494.[doi:10.13798/j.issn.1009-153X.2018.07.016]
[10]苗宏生 赵耀东 薛亚军 韩 骢 兰 津 楼美清.岩斜区脑膜瘤的显微手术入路选择和手术技巧(附23例报道)[J].中国临床神经外科杂志,2019,(01):22.[doi:10.13798/j.issn.1009-153X.2019.01.006]
 MIAO Hong-sheng,ZHAO Yao-dong,XUE Ya-jun,et al.Microsurgical approach selection and surgical techniques of petroclival meningioma (report of 23 cases)[J].,2019,(02):22.[doi:10.13798/j.issn.1009-153X.2019.01.006]
[11]兰 静 江普查 曹长军 陈礼道 赵宇航 杨 强.枕下乙状窦后入路显微手术切除听神经瘤的临床分析[J].中国临床神经外科杂志,2017,(09):665.[doi:10.13792017.09/j.issn.1009-153X.2017.09.021]
[12]谷速杰 李 俊 李闪闪 王 潞 范明波 张 章.听神经瘤切除术中内听道内肿瘤的个体化处理[J].中国临床神经外科杂志,2019,(02):69.[doi:10.13798/j.issn.1009-153X.2019.02.002]
 GU Su-jie,LI Jun,LI Shan-shan,et al.Individualized treatment of tumors in the internal auditory canals during resection of acoustic neuromas[J].,2019,(02):69.[doi:10.13798/j.issn.1009-153X.2019.02.002]

备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81602204);2015武汉市创新人才开发资金(2015whcxrczjxm02);华中科技大学同济医学院研究型临床医师资助计划(5001540025)
作者单位:430030 武汉,华中科技大学同济医学院附属同济医院神经外科(孙守家、赵 凯、王俊文、朱明欣、蒋 伟、杨正明、舒 凯、雷 霆);250012 济南,山东大学齐鲁医院神经外科(孙守家)
通讯作者:舒 凯,E-mail:kshu@tjh.tjmu.edu.cn
更新日期/Last Update: 2019-02-20