Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

被引:0
|
作者
Madjid Samii [1 ]
Amir Samii [1 ]
机构
[1] International Neuroscience Institute
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中图分类号
R686 [筋腱、韧带、滑囊疾病及损伤];
学科分类号
1002 ; 100210 ;
摘要
Background Vestibular schwannoma,the commonest form of intracranial schwannoma,arises from the Schwann cellsinvesting the vestibular nerve.At present,the surgery for vestibular schwannoma remains one of the most complicatedoperations demanding for surgical skills in neurosurgery.And the trend of minimal invasion should also be the majorinfluence on the management of patients with vestibular schwannomas.We summarized the microsurgical removalexperience in a recent series of vestibular schwannomas and presented the operative technique and cranial nervepreservation in order to improve the rates of total tumor removal and facial nerve preservation.Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibularschwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with smallcraniotomy.CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posteriorwall of the internal acoustic meatus to the bone labyrinths preoperatively.Brain stem evoked potential was monitoredintraoperatively.The posterior wall of the internal acoustic meatus was designedly drilled off.Patient records andoperative reports,including data from the electrophysiological monitoring,follow-up audiometric examinations,andneuroradiological findings were analyzed.Results Total tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases.The anatomicalintegrity of the facial nerve was preserved in 91.0% (132/145) of the cases.Intracranial end-to-end anastomosis of thefacial nerve was performed in 7 cases.Functional preservation of the facial nerve was achieved in 115 patients (Grade Iand Grade Ⅱ,79.3%).No patient died in this series.Preservation of nerves and vessels were as important as tumorremoval during the operation.CT thinner scan could show the relationship between the posterior wall of the internalacoustic meatus and bone labyrinths,that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus.Conclusions The goal of every surgery should be the preservation of function of all cranial nerves.Using theretrosigmoid approach with small craniotomy is possible even for large schwannomas.Knowing the microanatomy of thecerebellopontine angle and internal auditory meatus,intraoperating neurophysiological monitoring of the facial nervefunction,and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal andpreserving facial nerve function.
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页码:274 / 280
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