Lownie S P, Drake C G
Division of Neurosurgery, University of Western Ontario, London, Canada.
J Neurosurg. 1991 Mar;74(3):422-5. doi: 10.3171/jns.1991.74.3.0422.
Historically, the neurosurgical treatment of large acoustic neurinomas has developed with two principal goals: complete tumor removal and preservation of facial nerve function. A recent goal for small tumors is the preservation of hearing. Out of a personal series of 124 acoustic neurinomas treated over the past 35 years, the senior author has undertaken a radical intracapsular approach in 12 patients with large tumors (greater than 3 cm in diameter). Surgical indications for intracapsular removal included advanced age (five cases), the patient's wish to avoid any risk of facial paralysis (six cases), contralateral facial palsy (one case), and contralateral deafness (one case). Eleven of these 12 patients were available for follow-up review. Tumor recurrence developed in two patients (18%) at 2 and 3 years postoperatively; there were no late recurrences. Four patients died of unrelated causes, 10 to 19 years after surgery. The remaining five patients have survived a mean of 12 years since surgery without recurrence (range 3 to 22 years). Facial function was preserved in nine patients (82%). The results suggest that radical intracapsular removal may be the procedure of choice under certain circumstances and may offer an alternative to focused high-energy radiation.
从历史上看，大型听神经瘤的神经外科治疗发展有两个主要目标：完全切除肿瘤和保留面神经功能。近期对于小型肿瘤的目标是保留听力。在过去35年里治疗的124例听神经瘤的个人病例系列中，资深作者对12例大型肿瘤（直径大于3厘米）患者采用了根治性囊内入路。囊内切除的手术指征包括高龄（5例）、患者希望避免任何面瘫风险（6例）、对侧面瘫（1例）和对侧耳聋（1例）。这12例患者中有11例可供随访复查。2例患者（18%）在术后2年和3年出现肿瘤复发；无晚期复发。4例患者在术后10至19年死于无关原因。其余5例患者自手术以来平均存活12年无复发（范围3至22年）。9例患者（82%）的面部功能得以保留。结果表明，在某些情况下，根治性囊内切除可能是首选手术方法，并且可能为聚焦高能放疗提供一种替代方案。
