Cranial nerve preservation in surgery for large acoustic neuromas
Cranial nerve preservation in surgery for large acoustic neuromas
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DOI：
10.1055/s-2004-828699
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发表时间：
2004-05-01
影响因子：
--
通讯作者：
Jackman, AH
中科院分区：
文献类型：
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作者：
Roland, JT;Fishman, AJ;Jackman, AH
回顾性评价了切除大型听神经瘤后的面神经预后和其他颅神经的手术并发症发生率。我们回顾了1992年至2001年间在纽约大学医学中心接受听神经瘤手术切除的所有患者的病历。54例肿瘤尺寸为3 cm或更大的患者被纳入研究。4例患者患有2型神经纤维瘤病，其中2例接受了双侧听神经瘤切除术。56例中47例（84%）行经皮显微手术切除肿瘤。所有病例均采用肌电图监测、改良显微切割和超声抽吸。术后即刻和随访时使用House-Brackmann面神经分级系统评估面神经功能。90%的患者达到了House-Brackmann III级或更好，84%的患者达到了II级或更好。大型听神经瘤手术切除后，最终面神经预后极佳。术前颅神经麻痹在手术后也得到改善。对于大于或等于3cm的听神经瘤，我们选择了经皮神经鞘入路切除肿瘤。
Facial nerve outcomes and surgical complication rates for other cranial nerves were evaluated retrospectively after the resection of large acoustic neuromas. The charts of all patients who underwent surgical removal of an acoustic neuroma between 1992 and 2001 at New York University Medical Center were reviewed. Fifty-four patients with tumors measuring 3 cm or larger were included in the study. Four patients had neurofibromatosis type 2, two of whom underwent bilateral removal of acoustic neuromas. Translabyrinthine microsurgical removal of tumor was performed in 47 of 56 cases (84%). In all cases, EMG monitoring, improved sharp microdissection, and ultrasonic aspiration were employed. Facial nerve function was assessed using the House-Brackmann facial nerve grading system immediately after surgery and at follow-up visits. A House-Brackmann grade III or better was achieved in 90% of patients, and a grade II or better was achieved in 84% of patients. Ultimate facial nerve outcome was excellent after the surgical resection of large acoustic neuromas. Preoperative cranial nerve palsies also improved after surgery. The translabyrinthine approach for tumor removal is our treatment of choice for acoustic neuromas 3 cm or larger.