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目的总结 ６４例大型听神经瘤显微外科手术的体会，探讨面、听神经功能保留的可能性和可行性。方法５９例采用单侧枕下入路，５例巨大型累及岩尖斜坡者采用经岩入路，所有病例均采用显微外科技术行肿瘤切除术。结果肿瘤全切除５６例（８８％），次全切除７例，大部切除１例。面神经解剖保留５７例（８９％），功能保留４３例（６７％）。术前尚有听力者２２例，术后听力保存者６例（２７％）手术，死亡１例（１．５％）。结论大部分大型听神经瘤采用显微外科技术可行１期全切除和面神经的保留，强调保护桥脑腹外侧静脉丛和小脑前下动脉的重要性。对大型听神经瘤亦应争取面神经和听力的保留。
Objective To summarize the experience of 64 cases of large acoustic neuroma treated by microsurgery and explore the possibility and feasibility of preserving facial and auditory nerve function. Methods Fifty-nine patients underwent unilateral suboccipital approach and 5 patients underwent massive rock invasion involving petrous apex. All cases underwent microsurgical resection. Results Total resection of the tumor in 56 cases (88%), subtotal resection in 7 cases, most of the resection in 1 case. Facial nerve anatomy retained 57 cases (89%), retained function in 43 cases (67%). There were 22 cases of hearing loss before surgery, 6 cases (27%) of the survivors after surgery, 1 case (1.5%) died. Conclusion Most large acoustic neuromas adopt microsurgery to perform total resection and facial nerve preservation. Emphasis is placed on the importance of protecting the ventrolateral palsy and the anterior inferior cerebellar artery. For large acoustic neuroma should also strive for facial nerve and hearing retention.