Roberson J B, Brackmann D E, Hitselberger W E
House Ear Clinic, Los Angeles, CA 90057, USA.
Am J Otol. 1996 Mar;17(2):307-11.
Thirty-five patients with recurrent acoustic tumors have been studied before, during, and after revision surgery. Each had their original surgery via a suboccipital approach. Six patients had undergone multiple suboccipital surgeries. Revision surgery was accomplished using a translabyrinthine approach in all patients. Total tumor removal was possible in 33 patients. No second recurrences have occurred to date among the patients with total tumor removal. Anatomic facial nerve integrity was maintained in 24 patients. All recurrent tumors were present in the lateral internal auditory canal. Direct tumor access in this area is not possible with the suboccipital approach without entering the vestibular labyrinth. The suboccipital approach to acoustic neuromas is contraindicated if tumor extends to the fundus of the internal auditory canal. Translabyrinthine resection is the treatment of choice for recurrence of acoustic neuroma after primary suboccipital resection.
对35例复发性听神经瘤患者在翻修手术前、手术期间及手术后进行了研究。每例患者最初均通过枕下入路进行手术。6例患者接受了多次枕下手术。所有患者均采用经迷路入路完成翻修手术。33例患者实现了肿瘤全切。在肿瘤全切的患者中，至今未出现二次复发。24例患者的面神经解剖完整性得以保留。所有复发性肿瘤均位于内耳道外侧。采用枕下入路时，若不进入前庭迷路，则无法直接进入该区域的肿瘤。如果肿瘤延伸至内耳道底部，则枕下入路治疗听神经瘤为禁忌。经迷路切除术是原发性枕下切除术后听神经瘤复发的首选治疗方法。
