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背景与目的:大型听神经瘤在全切除肿瘤的同时保留患者的面、听神经功能是神经外科医生的难题,本研究探讨在面、听神经功能监护下,显微手术切除大型听神经瘤术后听力保留的可能性。方法:对2002年1月至2008年4月湘雅医院神经外科同一术者(袁贤瑞教授)在面肌肌电图和耳蜗神经监测下,经乙状窦后入路显微手术切除的127例大型听神经瘤手术中有完整听力随访资料的41例病例进行回顾性研究。听功能采用北京市耳鼻咽喉科研究所研制的普通话言语测试材料(mandarin speech test materials,MSTMs)句表进行言语识别率测试和纯音听阈测定(PTA),并使用New Hannover Classification听力分级法进行术后听力分级。结果:127例患者中,术中10例获得明确的听神经解剖学保留,其余117例术中未能找到确切的听神经。对随访到的41例听神经瘤患者进行术后听功能评价,听力保留率为26.8%。结论:对于有相当经验的神经外科医生来说,在面、听神经监护下,经乙状窦后-内听道入路显微手术全切除大型听神经瘤的同时可以保留部分患者的听神经功能。
BACKGROUND & OBJECTIVE: The purpose of large acoustic neuroma is to preserve the surface of the patient while totally excising the tumor. Auditory nerve function is a difficult problem for neurosurgeons. In this study, we investigated the effect of facial and auditory nerve function on microsurgical removal of large acoustic neuroma possibility. Methods: From January 2002 to April 2008, Xiangya Hospital, the same surgeon in neurosurgery (Professor Yuan Xianrui) under facial muscle EMG and cochlear nerve monitoring, retrosigmoid microsurgical resection of the 127 cases A retrospective study was performed on 41 cases with complete hearing follow-up data in large acoustic neuroma surgery. Listening function Speech recognition rate test and pure tone hearing threshold (PTA) were performed using the mandarin speech test materials (MSTMs) list developed by Beijing Institute of Otolaryngology, and the New Hannover Classification hearing method was used for postoperative Listening grading. Results: Among 127 patients, 10 cases were confirmed by auditory nerve anatomy and the remaining 117 cases were unable to find the exact auditory nerve. The follow-up of 41 cases of acoustic neuroma patients after hearing evaluation, hearing retention rate of 26.8%. CONCLUSIONS: For a well-experienced neurosurgeon, under the superficial and auditory nerve monitoring, transposition of the sigmoid sinus posterior-internal auditory canal microsurgery allows the removal of large acoustic neuromas while preserving the auditory nerve function of some patients.