伽玛刀治疗听神经瘤失败后再手术的方法及疗效分析

目的探讨伽玛刀治疗听神经瘤失败后再行手术治疗的方法及其效果。方法 20例听神经瘤患者接受伽玛刀治疗后不同时期复查MRI发现肿瘤继续生长或临床症状加重,采用枕下乙状窦后入路行听神经瘤切除术。结果术中发现肿瘤与面神经及周围结构粘连明显。肿瘤全切及近全切除共18例(占90%),次全切除共2例(占10%)。面神经解剖保留18例(占90%),功能保留16例(占80%)。结论采用枕下乙状窦后入路肿瘤切除术是挽救伽玛刀治疗听神经瘤失败后的有效方法,面神经功能保护满意。

Microsurgery and Gamma Knife Radiosurgery for Huge Acoustic Neuromas

Objective To investigate the microsurgery method and effect of recurrence acoustic neuromas after gamma knife treatment. Method 20 patients with tumor recurrence after treated with gamma knife. The sub-occipital retrosigmoid approaches were used in all patients to removal the tumors. Results The tumors were adherent to facial nerve and brainstem evidently. Total or near total tumor resection was achieved in 18 cases（90%）, and sub-total resection in 10 cases （10%）. The anatomical integrity of the facial nerve was preserved in 90%of the cases. At last follow-up, 80%of all patients had excellent or good facial nerve function. Conclusion Acoustic neuromas treated with gamma knife might recurrence with different interval. Trans-labyrinthine removal could be an effective salvage surgery, and the postoperative facial nerve function is satisfactory.