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1、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
2、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;R651.1lMicrosurgeryforRecurrentAcousticNeuromasYUJ一sheng,LEITing,CHENJin—COD,et.DepartmentofNeu
3、rosurgery,ronviHospital,ronviMed&dSchool,HuazhongUnwe~ofSciencesandTechnology,WuhanHubei430O30,China【Abstract】ObjectiveToexplorethecurativeeffectofmicrosurgeryonrecurrentacousticneuromas.MethodsTheclinicaldataof27patientsofrecurrentacousticneuromasundergoingmicrosurgeryinourdepartmentw
4、asanalyzedretrospectively.Of27patientswitIlrecurrentacousticneuromas.25underwentmicrosurgerythroughthesuboccipito-retrosigmoidapproachand2throughthesubtemporalapproach.Neuroendoscope-assistedmicrosurgerywasperformedin10patientswithrecurremacousticneuromas.ResultsInallthepatients,thetotally
5、resectionofthetumorsWasachievedin21andsubtota1.resecti0nin4,andpartialresectionin2.Thefacialnervewasanatomicallypreservedin12of16patientswhodidnothavefacialpalsyafterthefirstoperation.Twopatientshadcerebrospinalfluid(CSleakagefromthewoundandlCSFotorrhea.AccordingtotheGlasgowOutcomeScale,15
6、patientsreturnednormallife,8couldtake,careofthemselvesand4neededanotherperson'Shelptolife.Nopatientsdied.ConclusionsAlthoughtherecurrenttumorsoftenadheretothesurroundingfacialnervesandbrainstems,thegoodoutcomescanbeachievedbymicrosurgeryinmostpatientswithrecurrentacousticneuromas.Regularne
7、urological-imageexaminationafterthefirstsurgeryistheimportanthelpfultoearlydiagnosisandtreatmentinthepatientswithacousticneuromas.【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疗.同时随着显微外科及术中颅神经监测技术的广泛应用,使得听神经
