Sluyter S, Graamans K, Tulleken C A, Van Veelen C W
Department of Otorhinolanryngology and Neurosurgery, Utrecht University Medical Center, The Netherlands.
J Neurosurg. 2001 Jan;94(1):61-6. doi: 10.3171/jns.2001.94.1.0061.
The authors review the results of a series of 120 acoustic neuromas that were surgically treated via the translabyrinthine-transtentorial approach between 1986 and 1999.
The authors retrospectively evaluated a series of 120 acoustic neuromas with extrameatal diameters of 2 cm or greater, 99 (82.5%) of which had diameters longer than 3 cm. Complete tumor removal, as ascertained using computerized tomography or magnetic resonance imaging, was achieved in 110 patients (91.7%). The facial nerve was anatomically preserved in 97 patients (80.8%). The main postoperative complications were cerebrospinal fluid (CSF) leakage through the scalp wound (13.3%) requiring surgical revision in 2.5%, meningitis (9.2%), CSF rhinorrhea (6.7%) requiring surgical revision in 2.5%, and epileptic seizures (the only permanent complication) requiring medication (3.3%). There was no death directly related to the surgery. Long-term follow-up examination of the facial nerve revealed recovery of function to the level of House-Brackmann Grade I or II in 56.2% of the patients.
The results and complications presented in this series are comparable to those reported in the literature. The authors conclude that the combined translabyrinthine-transtentorial approach is a safe route for removing acoustic neuromas with a diameter of 2 cm or greater.
作者回顾了1986年至1999年间通过经迷路-经小脑幕入路手术治疗的120例听神经瘤的结果。
作者回顾性评估了一系列120例外耳道直径2 cm或更大的听神经瘤，其中99例（82.5%）直径超过3 cm。通过计算机断层扫描或磁共振成像确定，110例患者（91.7%）实现了肿瘤全切。97例患者（80.8%）面神经获得解剖保留。主要术后并发症包括头皮伤口脑脊液漏（13.3%），其中2.5%需要手术修复；脑膜炎（9.2%）；脑脊液鼻漏（6.7%），其中2.5%需要手术修复；以及癫痫发作（唯一的永久性并发症），需要药物治疗（3.3%）。没有直接与手术相关的死亡病例。对面神经的长期随访检查显示，56.2%的患者功能恢复至House-Brackmann I级或II级水平。
本系列研究呈现的结果和并发症与文献报道相当。作者得出结论，经迷路-经小脑幕联合入路是切除直径2 cm或更大听神经瘤的安全途径。
