听神经瘤切除面神经保留技术探讨

目的：探讨和分析中，大型听神经瘤手术面神经保留技术，方法：135例听神经瘤病人，采用枕下开颅乙状窦后经内听道人路，显微外切除肿瘤，在面神经监护下，观察肿瘤与面神经的病理解剖关系，术后随访时间4个月至3年，结果，肿瘤全切除125例（93％），近全切4例（2．9％），次全切6例（4．4％），面神经解剖保留122例（90％），13例（9％）解剖未能保留面神经，结论：术中首先识别不与肿瘤粘连的面神经脑干端及内听道端，再从再端沿面神经锐性分离肿瘤，是面神经解保留的技术关键。

Facial nerve reservation in acoustic neuroma surgery

Objective To summarize and analysis the skills of facial nerve reservation in acoustic neuroma surgery.Methods 135 patients harboring acoustic neuroma with larger and medium size were treated surgically by suboccipital retrosigmoid transmeatus approach for reserving facial nerve. The pathological anatomic relationships of tumor and facial nerve were studied, accompanied with nerve monitoring. Postoperative following up had continued from 4 months to 3 years. Results Total tumors resection was achieved in 125 of the 135 patients (93%), near total in 4 (2 6%) and subtotal in 6 (4 7%). Facial nerves was kept anatomic intact in 122(91%) of the patients. Conclusions It is key skill for keeping facial nerves anatomic intact to identify brainstem segment and intrameatus segment of facial nerves first, which is usually not stick on tumor, then separate the tumor along the nerve.