196Cases Of Acoustic Neurilemoma Resection And Facial Nerve Function Preservation Clinical Experience

Objective: acoustic neuroma is a benign tumor that develops on the acousticneurolemma. Nor multiple recurrent malignant transformation and metastasis, theincidence rate of about8%-12%of intracranial tumors, the total number ofcerebellopontine angle tumors75%-95%. More common in adults, average age37.3years, the peak age of onset is30-49years of age, accounting for60%of the total;15years of age and65years of age is rare, no significant gender differences. Most tumorslocated on the side, basically evenly distributed to the left and right sides, a few bilateral;bilateral acoustic schwannomas are neurofibromatosis, neurofibromatosis type Ⅱ is anautosomal dominant systemic disease. Its growth can cause the damage of cranial nerve,such as hearing loss, facial paralysis, cerebellar ataxia and other symptoms, which canresult in the psychological and physical damage of the patients. On the surgicaltreatment, if the tumor is cut completely, the patient can obtain a permanent cure. Alongwith the rapid development of modern microscopy, on the treatment of acousticneuroma, neurosurgeon has been studying from the full-cut of the tumor to the pursuitof the perfect post operation retention of facial nerve. This article mainly discusses theadvantages and disadvantages of surgical approach, the pros and cons of the incisionselection, the key points of the intraoperative tumor resection and the postoperativecomplications for the purpose of increasing the retention rate of facial nerve while surgical removal of the acoustic neuroma.Methods: a retrospective analysis, since2002, our department has treated a total of196patients with acoustic neuroma,summarizing the operation experience, comparing theadvantages and disadvantages of the approach, bone flap, tumor excision methods anddiscussing surgical techniques of the retention of facial nerve. Which includes six casesof neurofibromatosis type II.92cases were male, female104cases. Aged27to70years,mean50years of age. Duration of one month to28years, an average of3years and5months.89cases of tumor in the left side, the right side of107cases. Preoperativeperformance: ipsilateral tinnitus, hearing loss144cases,52cases of hearing loss, facialnumbness120cases, hoarseness, cough,32cases of facial paralysis60cases,80casesof physical barriers Freemasonry, headache, decreased visual acuity in56cases,vestibular neurological dysfunction in12cases, the affected limb pathological positivein4cases,4cases of stroke patients.Results: Among the196cases,181cases is total excision of the tumor microscopically,15cases is subtotal resected. Postoperative pathology all confirmed the preoperativediagnosis.187cases of facial nerve is successfully preserved, and9cases failed. Thereare176cases of facial nerve function retention,6cases of cerebellar hematoma, and10cases of upper respiratory tract infection, no deaths.Conclusion: Through this surgery clinical practice, it is concluded that more than90%of the acoustic neuroma can be cured by retrosigmoid approach surgery, the completeresection rate is not lower than " retrolabyrinthine approach ". The retention rate of thefacial nerve anatomy can reach more than95%.The recovery and the recovery time ofthe facial nerve function is related to tumor size.1-12months follow-up after dischargefunctional status of HB facial nerve grade: Class I88例(45.0%), II grade64cases(33.0%), grade III33例(17.0%), IV grade11cases (6.0%), V-VI grade0cases.For the experienced neurosurgeons, CLP listening is not a necessary condition forthe operation. There is no obvious difference between the retention rate of facial nervedissection in my department and the intraoperative CLP listening retention in theliterature reports. While the CLP physiological monitoring operation can lower the operation technology barrier for surgeons. For those inexperienced surgeons, it canimprove the retention rate of facial nerve. for the posterior fossa surgery, andintraoperative tight suture epidural reducing cerebrospinal fluid leakage, it can reducethe risk of postoperative fever. For the extremely rare acoustic neuroma, it can issue thetemporal sigmoid sinus approach without staging surgery.