Zhu Zhengjie, Wang Zhaoyan, Zhang Zhihua, Huang Qi, Yang Jun, Wu Hao
Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai 200092, China.
Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University Ear Institute, Shanghai 200092, China. Email:
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Mar;49(3):196-9.
To describe and analyze the surgical outcomes of modified enlarged translabyrinthine approach(ETLA), which is combined with middle ear eradication and blind sac technique.
A retrospective study was conducted on 28 patients who underwent surgery for vestibular schwannoma (VS) via modified ETLA from Jan. 2001 to Dec. 2012. The sizes of tumors were 25-52 mm[(38.2 ± 9.1) mm (X(-) ± s)]. Main outcomes measures included the rate of total removal, the rate of cerebral spinal fluid (CSF) leakage after surgery, complications, and intraoperative anatomical preservation of facial nerve and facial nerve function.
Among the 28 patients who underwent modified ETLA, the rate of total removal was 100%. There was no death after surgery via modified ETLA. The rate of CSF leakage after surgery was 3.5% (1/28). The rate of intraoperative anatomical preservation of facial nerve was 89.3% (25/28).Short-term and long-term good facial nerve function rates were 25.0% (7/28) and 42.9% (12/28), respectively.
Modified ETLA is suitable for VS>3 cm with extension to the anterior region of cerebellopontine angle, VS involve with labyrinth part of facial nerve, high jugular bulb, proposing sigmoid sinus and highly pneumatized temporal bone. This approach can provide a wide surgical field and well prevention of CSF leakage.
描述并分析改良扩大经迷路入路（ETLA）联合中耳根治及盲袋技术的手术效果。
对2001年1月至2012年12月期间28例行改良ETLA手术治疗前庭神经鞘瘤（VS）的患者进行回顾性研究。肿瘤大小为25 - 52 mm[（38.2 ± 9.1）mm（X(-) ± s）]。主要观察指标包括全切率、术后脑脊液（CSF）漏发生率、并发症以及术中面神经解剖保留情况和面神经功能。
28例行改良ETLA手术的患者中，全切率为100%。改良ETLA手术后无死亡病例。术后CSF漏发生率为3.5%（1/28）。术中面神经解剖保留率为89.3%（25/28）。面神经短期和长期良好功能率分别为25.0%（7/28）和42.9%（12/28）。
改良ETLA适用于直径>3 cm且向桥小脑角前部扩展、累及面神经迷路段、颈静脉球高位、乙状窦前移及颞骨气化程度高的VS。该入路可提供广阔的手术视野并有效预防CSF漏。
