DiTullio M V, Malkasian D, Rand R W
J Neurosurg. 1978 Jan;48(1):1-12. doi: 10.3171/jns.1978.48.1.0001.
Neurosurgeons have traditionally advocated the transmeatal suboccipital craniectomy as the procedure of choice in treating acoustic neuromas of all sizes. With this technique, complete tumor removal was achieved in 91% of our patients. Facial motor activity was fully preserved in 59% and it was only partially deficient in an additional 29%. Conversely, recent otological reports have proposed a more flexible attitute in which the size of the tumor dictates the form of surgical therapy. In that scheme, the universally applicable and clinically proven suboccipital craniectomy is replaced by a series of procedures (translabyrinthine, middle fossa, transsigmoidal), each of which differs in its anatomical and technical requirements. This necessity for several operations seems to stem from the failure of any particular approach either to provide adequate visualization of the entire pathological process, or to afford maximum opportunity for complete tumor removal. By employing these various techniques, total capsular removal has been generally achieved in only 71% of cases. A careful comparison and analysis of these individual procedures reaffirms the superiority of the posterior fossa approach.
传统上，神经外科医生一直主张采用经耳道枕下颅骨切除术作为治疗各种大小听神经瘤的首选手术方法。采用这种技术，我们91%的患者实现了肿瘤完全切除。59%的患者面部运动功能得以完全保留，另有29%的患者仅存在部分功能缺陷。相反，最近的耳科学报告提出了一种更为灵活的态度，即根据肿瘤大小决定手术治疗方式。在该方案中，普遍适用且经临床验证的枕下颅骨切除术被一系列手术（经迷路、中颅窝、乙状窦后）所取代，每种手术在解剖学和技术要求上各有不同。需要进行多种手术的必要性似乎源于任何一种特定方法都无法充分显示整个病理过程，或无法提供最大的肿瘤完全切除机会。通过采用这些不同技术，一般仅在71%的病例中实现了肿瘤包膜完全切除。对这些个别手术进行仔细比较和分析，再次证实了后颅窝手术方法的优越性。
