Liu James K, Dodson Vincent N, Jyung Robert W
Department of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States.
Otolaryngology/Head-and-Neck Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States.
J Neurol Surg B Skull Base. 2019 Jun;80(Suppl 3):S267-S268. doi: 10.1055/s-0039-1685534. Epub 2019 Apr 24.
The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function. The link to the video can be found at: https://youtu.be/zld2cSP8fb8 .
当听力丧失无法恢复时，经迷路入路有利于切除压迫脑干的大型听神经瘤。该入路通过乙状窦前通道提供了广阔的操作空间，且无需长时间牵拉小脑。还能在肿瘤底部早期识别面神经。在这份手术视频图谱手稿中，作者展示了经迷路入路显微手术切除大型囊性听神经瘤的分步技术。阐述了显微外科和颅底技术的细微之处，包括在保持神经外膜下解剖平面以保留面神经的同时进行肿瘤的囊外剥离。这种策略在保留面神经功能的同时最大限度地扩大了切除范围。肿瘤的微小残余部分附着于神经外膜。实现了肿瘤的近全切除，面神经在低阈值下能快速激发。除了术前已存在的听力丧失外，患者术后神经功能完好，面神经功能正常。总之，经迷路入路和神经外膜下剥离的应用是保留面神经功能的大型听神经瘤手术治疗手段中的重要策略。视频链接为：https://youtu.be/zld2cSP8fb8 。
