Harner S G, Beatty C W, Ebersold M J
Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55905.
Otolaryngol Head Neck Surg. 1990 Jul;103(1):40-5. doi: 10.1177/019459989010300106.
The need to preserve hearing during acoustic neuroma removal has rekindled interest in labyrinth-sparing procedures. This review of 11 years' experience with the retrosigmoid approach to acoustic neuroma removal includes 335 procedures in 332 patients. There were no intraoperative deaths; two patients died in the postoperative period. The facial nerve was preserved in 86.3% of procedures, and auditory function was preserved in 45 procedures (34% of those tumors were 2 cm or smaller). Postoperative complications occurred in 101 procedures, the most common being cerebrospinal fluid otorhinorrhea in 40 cases; 25 of these required secondary surgery. Meningitis occurred 16 times and aspiration 8 times; all other complications were less frequent. Tumor removal was incomplete in eight procedures; in only one of these cases has tumor recurred. The six recurrences usually were identified 5 or more years postoperatively. This has prompted us to follow patients for 7 years postoperatively. Major changes in our management include the use of the supine position and of electrophysiologic monitoring. Advantages of the approach are: (1) wide access to the tumor, (2) applicability to all tumor sizes, (3) potential to preserve facial and auditory function in all cases, and (4) ability to change procedure without sacrificing labyrinth. This review confirms our confidence in this approach to acoustic neuroma removal.
在切除听神经瘤时保留听力的需求重新激发了人们对保留迷路手术的兴趣。这篇对采用乙状窦后入路切除听神经瘤11年经验的综述涵盖了332例患者的335次手术。术中无死亡病例；2例患者在术后死亡。86.3%的手术保留了面神经，45例手术保留了听觉功能（34%的肿瘤直径为2厘米或更小）。101例手术出现术后并发症，最常见的是脑脊液耳鼻漏40例；其中25例需要二次手术。脑膜炎发生16次，误吸8次；所有其他并发症较少见。8例手术肿瘤切除不完全；其中仅1例肿瘤复发。6例复发通常在术后5年或更长时间被发现。这促使我们对患者进行术后7年的随访。我们管理上的主要变化包括采用仰卧位和电生理监测。该入路的优点是：（1）能广泛暴露肿瘤，（2）适用于所有大小的肿瘤，（3）在所有病例中都有可能保留面神经和听觉功能，（4）能够改变手术方式而不牺牲迷路。这篇综述证实了我们对这种切除听神经瘤方法的信心。
