Pellet W, Cannoni M, Pech A, Triglia J M
Service de Neuro-chirurgie, Hôpital Sainte-Marguerite, Marseille.
Rev Neurol (Paris). 1987;143(8-9):614-9.
From 1973 until November 1984, 224 cerebello-pontine angle tumors, 180 of them isolated neurinomas, were operated on. In a large majority of cases (160) through the widened trans-labyrinthine approach, advocated by House and Hitselberger was used. Despite advances in diagnostic procedures two out of three of these neurinomas were discovered only when they were already quite big. The post-operative overall death rate was 5 p. 100, tumor removal was complete in 96 p. 100 of cases and the facial nerve continuity was respected in 87 p. 100 of cases. These overall results can be still improved because in the last 50 cases, no death occurred, the removal was always total and the facial nerve continuity was respected in 96 p. 100 of cases. The problem of hearing preservation, impossible by this approach, is discussed. The necessity of facial nerve preservation and total removal, in order to prevent recurrence, is emphasized. It often seems very difficult to preserve hearing and to completely remove the tumor and at the same time, have the highest chance of saving the facial nerve.
从1973年到1984年11月，共对224例桥小脑角肿瘤进行了手术，其中180例为孤立性神经鞘瘤。在大多数病例（160例）中，采用了豪斯（House）和希策尔贝格尔（Hitselberger）倡导的扩大经迷路入路。尽管诊断方法有所进步，但这些神经鞘瘤中有三分之二是在长得相当大时才被发现。术后总死亡率为0.5%，96%的病例肿瘤完全切除，87%的病例面神经连续性得以保留。这些总体结果仍可进一步改善，因为在最后50例病例中，无死亡发生，肿瘤均完全切除，96%的病例面神经连续性得以保留。文中讨论了通过这种入路无法保留听力的问题。强调了保留面神经和完全切除肿瘤以防止复发的必要性。通常，要同时保留听力、完全切除肿瘤并最大程度地保留面神经似乎非常困难。
