Alzhrani Gmaan, Shelton Clough, Couldwell William T
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
Acta Neurochir (Wien). 2017 Jun;159(6):1023-1026. doi: 10.1007/s00701-017-3169-1. Epub 2017 Apr 11.
Surgical approaches for removal of vestibular schwannoma are done through retrosigmoid, translabyrinthine, or middle fossa approaches, depending on the tumor size, preoperative hearing status, surgical team experience, and patient preference. The middle fossa approach (MFA) for the vestibular schwannoma (VS) route preserves hearing and can be done with minimal morbidity and mortality.
The authors discuss the surgical anatomy of the middle fossa, internal auditory canal localization techniques, MFA indications and the procedure for VS removal, and outcome.
Unlike otolaryngologists, who use the MFA to treat various pathological processes that involve the inner or middle ear, many neurosurgeons are unfamiliar with the MFA. Nevertheless, learning the technical nuances of the MFA adds to the neurosurgeon's armamentarium, especially for treatment of small intracanalicular VSs in young patients who wish to preserve hearing.
根据肿瘤大小、术前听力状况、手术团队经验和患者偏好，可通过乙状窦后、经迷路或中颅窝入路切除前庭神经鞘瘤。中颅窝入路（MFA）切除前庭神经鞘瘤（VS）可保留听力，且手术的发病率和死亡率极低。
作者讨论了中颅窝的手术解剖、内耳道定位技术、MFA的适应证、VS切除手术步骤及结果。
与使用MFA治疗涉及内耳或中耳的各种病理过程的耳鼻喉科医生不同，许多神经外科医生并不熟悉MFA。然而，掌握MFA的技术细节可丰富神经外科医生的手术方法，尤其适用于希望保留听力的年轻患者的小型内耳道VS的治疗。
