Ramsay H A, Luxford W M
House Ear Institute, Los Angeles, California.
J Laryngol Otol. 1993 Apr;107(4):295-7. doi: 10.1017/s0022215100122868.
Controversy regarding the best and safest treatment of acoustic tumours in elderly patients still exists. These patients may therefore end up having either microsurgical tumour removal, stereotactic radiosurgery or no treatment at all, depending on where the treatment decision is made. We evaluated the results of microsurgery for acoustic tumour removal in 65 patients who were 70 years of age or older. Surgery was performed between 1982 and 1989, using the translabyrinthine approach. Total tumour removal was achieved in 61 patients (94 per cent). No deaths due to surgery occurred. Other than one case of meningitis, there were no serious complications. Seven cases had post-operative CSF leaks, and three required surgery for correction of the problem. Facial nerve function pre-operatively, at the time of discharge and at one year or more post-operatively was compared to that in a younger age group. No differences between the groups were found. Nor was there any significant difference in mean operative time, blood loss, or hospital stay between the older and younger patients. We believe that total microsurgical tumour removal is the treatment of choice in patients who are in good health, regardless of age. Partial removal is acceptable only if the tumour is adherent to the facial nerve or if vital-sign changes occur during surgery. Other forms of treatment are reserved for cases where surgery is contraindicated or refused by the patient.
关于老年患者听神经瘤的最佳和最安全治疗方法仍存在争议。因此，这些患者最终可能接受显微手术切除肿瘤、立体定向放射外科治疗或根本不接受治疗，这取决于治疗决策的做出地点。我们评估了65名70岁及以上患者接受听神经瘤显微手术切除的结果。手术于1982年至1989年间进行，采用经迷路入路。61名患者（94%）实现了肿瘤全切。无手术相关死亡病例。除1例脑膜炎外，无严重并发症。7例出现术后脑脊液漏，3例需要手术纠正该问题。将术前、出院时及术后1年或更长时间的面神经功能与较年轻年龄组进行了比较。未发现两组之间存在差异。老年患者与年轻患者在平均手术时间、失血量或住院时间方面也无显著差异。我们认为，无论年龄大小，对于身体健康的患者，显微手术全切肿瘤是首选治疗方法。仅当肿瘤与面神经粘连或手术过程中出现生命体征变化时，部分切除才是可接受的。其他治疗形式则适用于手术禁忌或患者拒绝手术的情况。
