Harner S G, Ebersold M J
J Neurosurg. 1985 Aug;63(2):175-9. doi: 10.3171/jns.1985.63.2.0175.
The surgical aspects of 162 consecutive procedures for removal of acoustic neuromas, performed from 1978 through 1983, are reviewed. Nearly all of the procedures were done through a retrosigmoid suboccipital craniectomy. Most used the combined skills of a neurosurgeon and an otological surgeon. Total tumor removal was accomplished in 98% of cases. There have been two recurrences and one postoperative death. The facial nerve was preserved in 81% of procedures. Facial function returned in nearly all of these patients, but the degree of return was variable. The cochlear nerve was preserved in 55 patients, but hearing was present in only 14. The most common complication was cerebrospinal fluid otorhinorrhea (12%); about half of these patients required a secondary procedure. Other complications were meningitis (5%), aspiration (3%), and hemorrhage (2%). During the period reviewed, several changes occurred in management of this disorder. These procedures are now being done by a surgical team. The neurosurgeon performs the intracranial work and the otological surgeon accomplishes the temporal bone dissection. Most patients undergo the operation in the supine rather than the sitting position. During the operation, the facial nerve is monitored continuously by electromyography with intermittent bipolar stimulation. There appears to be continuing improvement in the management of these patients.
回顾了1978年至1983年期间连续进行的162例听神经瘤切除术的手术情况。几乎所有手术均通过乙状窦后枕下颅骨切除术进行。大多数手术由神经外科医生和耳科医生联合完成。98%的病例实现了肿瘤全切。出现了2例复发和1例术后死亡。81%的手术保留了面神经。几乎所有这些患者的面神经功能都得以恢复，但恢复程度各不相同。55例患者保留了蜗神经，但仅有14例患者术后仍有听力。最常见的并发症是脑脊液耳鼻漏（12%）；其中约一半患者需要二次手术。其他并发症包括脑膜炎（5%）、误吸（3%）和出血（2%）。在回顾期间，该疾病的治疗发生了一些变化。现在这些手术由一个手术团队完成。神经外科医生进行颅内手术，耳科医生完成颞骨解剖。大多数患者手术时采用仰卧位而非坐位。手术过程中，通过肌电图和间歇性双极刺激持续监测面神经。这些患者的治疗似乎在不断改进。
