-
摘要: 听神经瘤是桥脑小脑角区最常见的良性肿瘤,常见症状包括单侧感音性听力下降、耳鸣、眩晕等。手术切除是听神经瘤的主要治疗方式,常用入路包括以耳科为主的经迷路入路、经耳囊入路、扩大经迷路入路、改良经耳囊入路和颅中窝入路,以神经外科为主的枕下乙状窦后入路等。一般建议听力良好的小肿瘤选择颅中窝入路;肿瘤较大、希望保留听力者采用枕下乙状窦后入路;不考虑保留听力且为中、小型听神经瘤者,可采用经迷路入路或经耳囊入路。随着显微外科技术的发展以及术中神经监测设备的广泛应用,中、小型听神经瘤手术的面/听神经功能保留率已有显著提高,未来更多的听神经瘤患者有望在保留面/听神经功能的基础上获得治愈。Abstract: Acoustic neuroma is the most common benign tumor in the internal auditory canal and cerebellopontine region.Its common clinical symptoms include unilateral sensorineural hearing loss, tinnitus and so on.Surgical resection is the predominant treatment of acoustic neuroma. The common approaches dominated by otologists include translabyrinthine approach, enlarged translabyrinthine approach, transotic approach, modified transotic approach, and middle cranial fossa approach; the approach dominated by neurosurgeons is retrosigmoid (suboccipital) approach. For small tumors with intact hearing, it is recommended to choose the middle cranial fossa approach. Those with large tumors who wish to preserve their hearing can adopt the suboccipital retrosigmoid approach; those who do not consider retaining hearing and have medium or small acoustic neuromas can adopt the translabyrinthe approach or through the transotic approach. With the development of microsurgical technology and the wide application of intraoperative nerve monitoring equipment, the retention rate of facial/cochlear nerve function for surgery of small and medium-sized acoustic neuroma has been significantly improved. In the future, more patients with acoustic neuroma are expected to be completely cured on the basis of preserving facial/cochlear nerve function.
-
Key words:
- acoustic neuroma /
- treatment strategy /
- surgery approaches
作者贡献:王璞负责论文撰写和修改; 夏寅负责选题设计、指导论文撰写。利益冲突:无 -
[1] Marinelli JP, Lohse CM, Carlson ML. Incidence of Vesti-bular Schwannoma over the Past Half-Century: A Population-Based Study of Olmsted County, Minnesota[J]. Otolaryngol Head Neck Surg, 2018, 159: 717-723. doi: 10.1177/0194599818770629 [2] Reznitsky M, Petersen M, West N, et al. Epidemiology of Vestibular Schwannomas-Prospective 40-Year Data From An Unselected National Cohort[J]. Clin Epidemiol, 2019, 11: 981-986. doi: 10.2147/CLEP.S218670 [3] Dunn IF, Bi WL, Erkmen K, et al. Medial acoustic neuromas: clinical and surgical implications[J]. J Neurosurg, 2014, 120: 1095-1104. doi: 10.3171/2014.1.JNS131701 [4] Dunn IF, Bi WL, Mukundan S, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Manage-ment of Patients With Vestibular Schwannomas[J]. Neurosurgery, 2018, 82: E32-E34. doi: 10.1093/neuros/nyx510 [5] Carlson ML, Link MJ. Vestibular Schwannomas[J]. N Engl J Med, 2021, 384: 1335-1348. doi: 10.1056/NEJMra2020394 [6] 中国颅底外科多学科协作组. 听神经瘤多学科协作诊疗中国专家共识[J]. 中华医学杂志, 2016, 96: 676-680. doi: 10.3760/cma.j.issn.0376-2491.2016.09.002 [7] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 听神经瘤诊断和治疗建议[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49: 181-186. doi: 10.3760/cma.j.issn.1673-0860.2014.03.002 [8] Mastronardi L, Cacciotti G, Roperto R, et al. Negative influence of preoperative tinnitus on hearing preservation in vestibular schwannoma surgery[J]. J Neurosurg Sci, 2020, 64: 537-543. http://www.ncbi.nlm.nih.gov/pubmed/28945052 [9] Starnoni D, Giammattei L, Cossu G, et al. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section[J]. Acta Neurochir (Wien), 2020, 162: 2595-2617. doi: 10.1007/s00701-020-04491-7 [10] Nguyen-Huynh AT, Jackler RK, Pfister M, et al. The aborted early history of the translabyrinthine approach: a victim of suppression or technical prematurity[J]. Otol Neurotol, 2007, 28: 269-279. doi: 10.1097/MAO.0b013e31802b3264 [11] House WF. Transtemporal Bone Microsurgical Removal of Acoustic Neuromas. Evolution of Transtemporal Bone Removal of Acoustic Tumors[J]. Arch Otolaryngol, 1964, 80: 731-742. doi: 10.1001/archotol.1964.00750040747016 [12] 夏寅. 听神经瘤手术径路的选择[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49: 187-190. doi: 10.3760/cma.j.issn.1673-0860.2014.03.003 [13] Ölander C, Gudjonsson O, Kinnefors A, et al. Complica-tions in translabyrinthine surgery of vestibular schwannoma[J]. Acta Otolaryngol, 2018, 138: 639-645. doi: 10.1080/00016489.2018.1427887 [14] 王正敏. 王正敏耳显微外科学[M]. 上海: 上海科技教育出版社, 2004. [15] Falcioni M, Taibah A, Di Trapani G, et al. Inner ear extension of vestibular schwannomas[J]. Laryngoscope, 2003, 113: 1605-1608. doi: 10.1097/00005537-200309000-00037 [16] Hardy DG, Macfarlane R, Baguley D, et al. Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations[J]. J Neurosurg, 1989, 71: 799-804. doi: 10.3171/jns.1989.71.6.0799 [17] Jenkins HA, Fisch U. The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle[J]. Am J Otol, 1980, 2: 70-76. http://www.ncbi.nlm.nih.gov/pubmed/6971060 [18] Xia Y, Zhang W, Li Y, et al. The transotic approach for vestibular schwannoma: indications and results[J]. Eur Arch Otorhinolaryngol, 2017, 274: 3041-3047. doi: 10.1007/s00405-017-4627-3 [19] Browne JD, Fisch U. Transotic approach to the cerebellopontine angle. 1992[J]. Neurosurg Clin N Am, 2008, 19: 265-278, vi. doi: 10.1016/j.nec.2008.02.008 [20] Chen JM, Fisch U. The transotic approach in acoustic neuroma surgery[J]. J Otolaryngol, 1993, 22: 331-336. http://europepmc.org/abstract/MED/8283500 [21] Angeli RD, Piccirillo E, Di Trapani G, et al. Enlarged translabyrinthine approach with transapical extension in the management of giant vestibular schwannomas: personal experience and review of literature[J]. Otol Neurotol, 2011, 32: 125-131. doi: 10.1097/MAO.0b013e3181ff7562 [22] Naguib MB, Saleh E, Cokkeser Y, et al. The enlarged translabyrinthine approach for removal of large vestibular schwannomas[J]. J Laryngol Otol, 1994, 108: 545-550. doi: 10.1017/S0022215100127392 [23] 顾兴智, 尤乐都斯·克尤木, 吴皓. 经扩大迷路径路显微手术切除大型听神经瘤[J]. 听力学及言语疾病杂志, 2014(3): 253-256. doi: 10.3969/j.issn.1006-7299.2014.03.006 Gu XZ, Youledusi K, Wu H. Expanding Translabyrinthine Approach Microsurgery Resection of Large Acoustic Neuroma[J]. Tinglixu Ji Yanyu Jibing Zazhi, 2014(3): 253-256. doi: 10.3969/j.issn.1006-7299.2014.03.006 [24] 夏寅, 薛玉斌, 贾桂军, 等. 改良经耳囊径路在听神经瘤手术中的初步应用[J]. 中华神经外科杂志, 2018, 34: 30-33. doi: 10.3760/cma.j.issn.1001-2346.2018.01.007 Xia Y, Xue YB, Jia GJ, et al. Preliminary application of modified transotic approach in acoustic neuroma surgery[J]. Zhonghua Shenjing Waike Zazhi, 2018, 34: 30-33. doi: 10.3760/cma.j.issn.1001-2346.2018.01.007 [25] House WF. Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa[J]. Laryngoscope, 1961, 71: 1363-1385. http://ci.nii.ac.jp/naid/20000676239 [26] House F, Hitselberger WE. The middle fossa approach for removal of small acoustic tumors[J]. Acta Otolaryngol, 1969, 67: 413-427. doi: 10.3109/00016486909125467 [27] DeMonte F, Gidley PW. Hearing preservation surgery for vestibular schwannoma: experience with the middle fossa approach[J]. Neurosurg Focus, 2012, 33: E10. [28] 夏寅. 颅中窝径路-House与Fisch比较[J]. 中华耳科学杂志, 2017, 15: 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHER201701010.htm Xia Y. Middle Cranial Fossa Approach: House versus Fisch Techniques[J]. Zhonghua Erkexue Zazhi, 2017, 15: 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHER201701010.htm [29] Fisch U. Transtemporal supralabyrinthine (middle cranial fossa) vestibular neurectomy: a review of the last 100 cases[J]. Skull Base Surg, 1996, 6: 221-225. doi: 10.1055/s-2008-1058629 [30] 夏寅, 张文阳. 听神经瘤治疗策略[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25: 10-14. doi: 10.11798/j.issn.1007-1520.201901002 Xia Y, Zhang WY. Treatment strategies for vestibular schwannomas[J]. Zhongguo Erbi Yanhou Ludi Waike Zazhi, 2019, 25: 10-14. doi: 10.11798/j.issn.1007-1520.201901002 [31] 董李, 张军. 10年单中心听神经瘤患者手术治疗回顾性研究[J]. 中华耳科学杂志, 2020, 18: 20-24. doi: 10.3969/j.issn.1672-2922.2020.01.004 Dong L, Zhang J. Summary of Vestibular Schwannoma Cases treated with Microsurgery: Ten Years Experiences at a Single-Center[J]. Zhonghua Erkexue Zazhi, 2020, 18: 20-24. doi: 10.3969/j.issn.1672-2922.2020.01.004 [32] Huang X, Xu M, Xu J, et al. Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach[J]. World Neurosurg, 2017, 99: 326-335. doi: 10.1016/j.wneu.2016.12.055 [33] Mastronardi L, Gazzeri R, Barbieri FR, et al. Postoperative Functional Preservation of Facial Nerve in Cystic Vestibular Schwannoma[J]. World Neurosurg, 2020, 143: e36-e43. doi: 10.1016/j.wneu.2020.04.018
点击查看大图
计量
- 文章访问数: 583
- HTML全文浏览量: 141
- PDF下载量: 106
- 被引次数: 0