|
Objective To observe the nerve under the monitoring of the sigmoid sinus after auditory canal approach microsurgical removal of large, giant listen neuroma prognosis, assessment of surgical efficacy, and explore how to effectively protect patients face, auditory nerve function and improve the quality of life of patients . Neurosurgery Xiangya Hospital of Central South University since January 2002 to November 2009 by Professor Yuan Xianrui surgeon surgery 192 cases of acoustic neuroma results of follow-up and were analyzed retrospectively. Follow-up by telephone and patient referral, check the records of patients with systemic auditory nerve function and special surface. Facial nerve function records after seven days, in March, June, September, 1 year and forward to the House-Brackmann (HB) facial nerve function classification as an evaluation index. Hearing tests completed by the ENT professional technicians, including pure tone hearing threshold determination (Pure-tone Audiometry PTA) and Speech recognition (Speech Discramination Score, SDS), the American Academy of Otolaryngology - Head and Neck Surgery (American academy of otolaryngology-head results and neck surgery, AAO-HNS) grading standards proposed hearing evaluation. To assess the quality of life of patients Karnofsky scale. Results of linear and non-parametric tests of statistical methods for analysis. Results 192 patients with tumor diameter 20-65mm, an average of 42.4 ± 9.8mm. All tumor approach for resection of the sigmoid sinus. 192 cases in 183 cases of total resection, total resection rate of 95.3%. 9 cases not total resection (4.7%), which subtotal resection (removal of more than 95%) in 7 cases, subtotal resection (resection gt; 90%) in 1 case, part of the resection in 1 case. The postoperative death three cases, the mortality rate was 1.6% (3/192). Facial nerve complete anatomy of to retain 185 cases, accounting for 96.4%. Preoperative clinical data of 187 patients with facial nerve function in normal and near normal (HB 1/2 level) for a total of 175 people, accounting for 93.6% of the total. Facial nerve function of the follow-up study of 147 cases, the follow-up period of greater than one year a total of 106 cases, an average follow-up time was 3.0 ± 1.8 years. 106 cases patients, facial nerve function to normal by 46 Li (43.4%), nearly normal (HB2 level) 42 cases (39.6%), HB 3 Ji 10 Li (9.4%), level HB 4 7 Li (6.6%), HB 5 cases (0.9%). Excellent rate of facial nerve function (HB 1/2 level), 83.0% (88/106). The tumor diameter lt; 30mm small and medium-sized listening to nerve tumor Li tracking of facial nerve function belongs to HB 1/2 Ji 9 Li, accounting for 90%; tumor diameter ≥ 30mm large listening to neuroma of 96 cases, tracking observation plane nerve function belongs to HB 1 / 2 of 79 cases, accounting for 82.3%. In the long-term facial nerve function and tumor size, cystic, the internal auditory canal to expand the relationship between the duration of symptoms, age, statistical analysis of linear and non-parametric tests show the facial nerve function related to tumor size linear, with the other factors reflect the correlation. 168 patients with preoperative hearing information, useful hearing (AAO-HNS A, B grade), 21 cases (12.5%). Retain useful hearing after seven patients, belonging to the AAO-HNS A 1 case of grade, B grade six cases, five patients with preoperative hearing are useless hearing (AAO-HNS C / D grade). Seven patients were large acoustic neuroma, tumor diameter the average 43.6mm (35-60mm). Hearing of 21 patients in the preoperative and postoperative retained useful hearing two cases, hearing preservation rate was 9.5% (2/21). Postoperative Karnofsky quality of life score greater than or equal to the 80% accounted for 89.8%, and greater than or equal to 70% and 98%. Conclusion 1, after sigmoid sinus approach removal of large, giant acoustic neuroma in the preservation of the facial nerve may also retain the cochlear nerve, the removal of large and giant acoustic neuroma preferred approach. The vast majority of acoustic neuroma patients after sigmoid sinus into the road be able to get a good long-term facial nerve function after resection. 2, tumor size still affect the result of listening to neuroma microsurgery in patients with facial nerve function after major factors, other factors such as age, duration of symptoms, tumor cystic adhesions or together with tumor size affect facial nerve function. 3, despite the removal of large acoustic neuromas (diameter ≥ 30mm) cochlear nerve preservation is difficult, but not impossible. Therefore, regardless of tumor size and preoperative hearing status, we can not give up efforts to retain the cochlear nerve.
|