Chen J M, Fisch U
Department of Otolaryngology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
J Otolaryngol. 1993 Oct;22(5):331-6.
A consecutive series of 147 transotic operations for the removal of acoustic neuroma is presented. The advantages of this approach over the conventional translabyrinthine technique are several, including 1) a wider surgical access with a circumferential exposure of the internal acoustic meatus and the porus acousticus; 2) the direct visualization and access to the anterior cerebellopontine angle where the facial nerve is usually tenuous and most vulnerable; and 3) the permanent closure of the ear canal and eustachian tube with complete obliteration of the surgical cavity, minimizing cerebrospinal fluid leaks. These advantages have translated into improved surgical outcomes. In our series of 147 patients spanning 11 years, total tumor extirpation was achieved in all patients, with one mortality, three CSF leaks, and one meningitis. The facial nerve was anatomically preserved in 95% of the cases. This approach is capable of attaining the widest, and the most direct access to the cerebellopontine angle without cerebellar retraction.
本文介绍了连续147例经外耳道入路切除听神经瘤的手术。该方法相对于传统经迷路技术具有多个优点，包括：1）手术入路更宽，可环形暴露内耳道和听神经孔；2）能直接观察并进入面神经通常纤细且最易受损的桥小脑角前部；3）可永久性封闭耳道和咽鼓管，完全消除手术腔隙，将脑脊液漏降至最低。这些优点带来了更好的手术效果。在我们长达11年的147例患者系列中，所有患者均实现了肿瘤全切，1例死亡，3例脑脊液漏，1例脑膜炎。95%的病例面神经在解剖学上得以保留。该方法能够在不牵拉小脑的情况下，实现对桥小脑角最广泛、最直接的显露。
