Shelton C, Alavi S, Li J C, Hitselberger W E
Division of Otolaryngology, University of Utah, Salt Lake City, USA.
Am J Otol. 1995 Sep;16(5):664-8.
The authors have used a modified retrosigmoid (suboccipital) approach for removal of acoustic tumors in selected patients who have good preoperative hearing and whose tumor does not reach the brain stem or extend to the lateral third of the internal auditory canal. This report presents the surgical technique and results for 15 acoustic neuromas removed by members of the House Ear Clinic between 1986 and 1991 using this approach. The technique differs importantly from the standard suboccipital approach. A mastoidectomy with decompression of the sigmoid sinus allows forward retraction of the sigmoid sinus, enabling tumor removal without cerebellar retraction. Also, replacement of the craniotomy flap prevents adherence to the dura of the scalp, which may prevent postoperative headaches. Tumor size ranged from 0.8 cm to 4.0 cm (mean, 1.9 cm). At 1 year or more postoperative, 13 of the 14 patients with follow-up available had a House-Brackmann (H-B) facial nerve grade I, and one patient had H-B grade II. Three patients retained good hearing ( < or = 30 dB SRT and > or = 70% speech discrimination) postoperatively, and 57% retained at least measurable hearing. For a patient with good preoperative hearing and a tumor that is medially based, involving the cerebellopontine angle but not extending to the brain stem or the lateral end or the internal auditory canal, the authors will continue to use the retrosigmoid approach for tumor removal.
对于部分术前听力良好且肿瘤未侵犯脑干或未延伸至内耳道外侧三分之一的患者，作者采用改良乙状窦后（枕下）入路切除听神经瘤。本报告介绍了1986年至1991年间豪斯耳科诊所的医生使用该入路切除15例听神经瘤的手术技术及结果。该技术与标准枕下入路有显著差异。行乳突切除并减压乙状窦，可使乙状窦向前移位牵拉，从而在不牵拉小脑的情况下切除肿瘤。此外，颅骨切开骨瓣复位可防止其与头皮硬脑膜粘连，进而预防术后头痛。肿瘤大小在0.8厘米至4.0厘米之间（平均1.9厘米）。术后1年或更长时间，14例有随访资料的患者中，13例面神经功能为豪斯-布拉克曼（H-B）I级，1例为H-B II级。3例患者术后保留了良好听力（言语识别阈≤30分贝且言语识别率≥70%），57%的患者至少保留了可测量的听力。对于术前听力良好且肿瘤位于内侧、累及桥小脑角但未延伸至脑干、内耳道外侧端的患者，作者将继续采用乙状窦后入路切除肿瘤。
