听神经瘤手术对面神经功能保留的影响因素(2)
6 其他影响面神经功能因素
6.1 术前其他治疗 伽玛刀治疗,放射治疗,化疗等也是影响手术难度的一个重要因素。
6.2 术前面神经损伤程度
6.3 手术医生的体力和耐力 大型听神经瘤显微手术全切并保留面神经功能,不仅是对神经外科医生技术的考验而且也是体力和耐力的考验。
总之,很多因素影响听神经瘤术后面神经功能,我们要充分利用显微神经外科技术,遵循合理的手术策略,配合术中神经电生理监测以提高听神经瘤全切率和面神经保留率。如果听神经瘤做到早发现,早诊断,在面神经没有离断或严重受压变形,血供没有受影响时,利用娴熟的显微外科技术积极手术治疗,将为进一步提高面神经功能保留率提供更大可能。
参 考 文 献
, 百拇医药
[1] Utermark T, Kaempchen K, Hanemann CO. Pathological adhesion of primary human schwannoma cells is dependent on altered expression of integrins.Brain Pathol,2003,13(3);352-363.
[2] Grant GA, Rostomily RR, Kim DK, et al. Delayed facial palsy after resection of vestibular schwannoma. J Neurosurgery,2002, 97(1):93-96.
[3] McElveen JT Jr,Belmonte G, Fukushima T, et al.A review of facial nerve outcome in 100 consecutive cases of acoustic tumor surgery.Laryngoscope,2000,110(10)1667-1672.
, http://www.100md.com
[4] Gormly WB, Sekhar LN, Wright DC,et al.Acoustic neuromas:results of current surgical management.Neurosurgery,1997,41(1):50-58.
[5] House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head neck surg,1985,93(2):146-147.
[6] Sampath P, Holliday MJ, Brem H, et al.Facial nerve injury in acoustic neuroma(restibalar schwannoma) surgery:etiology and prevention.J Neurosurg,1997,87:60-66.
, http://www.100md.com
[7] 于春江,王忠诚,关树深,等.听神经瘤切除面神经保留技术探讨.中华神经外科杂志,2001,17:174-177.
[8] Mari K, A tsunobu T, A tsushi K, et al. Distance From Acoustic Neuroma to Fundus and a Postope rative Facial Palsy. The La ryngoscope,2002,112 (1):168-171.
[9] 李龄.听神经瘤治疗现状.中华神经外科杂志,2000,16(增刊):108-110.
[10] Zhang X,Fei Z,Fu LA,et al. Microsurgical management oflarge acoustic neuromas. Chin J Neurosurg Dis Res,2004,3 (1):25-29.
, 百拇医药
[11] Goldbrunner RH, Schlake HP, Milew ski C, et al. Quantitative parameters of in traoperative electromyography predict facial nerve outcomes for vestiblarschwannoma surgery. Neurosurgery,2000,46(5):1140-1148.
[12] Yamakami I, Uchino Y, kobayashi E, et al. Removel of large acoustic no mortality and minimal morbidity. J Neurol neurosurg Psychiatry,2004,75(3):453-458.
[13] Samii M, Mat t hies C. Management of 1000 vestibulschwannomas(acoustic neuromas):t he facial nerve presevation and restitution of function. Neurosurgery,1997,40(4):684-694.
, 百拇医药
[14] Skrivan J,Zverina E,Bet ka J,et al. Our surgical experiencwit h large vestibular schwannomas. Otolaryngol Pol.2004,58 (1):69-72.
[15] Collet ti V, Fiorino F, Policante Z, et al. Int raoperativemonitoring of facial nerve antidromic potentials during acoustic neuroma surgery. Acta Otolaryngol,1997,117(5):663-669.
[16] Sampath P,Rini D,Long DM. Microanatomical variations inthecerebellopontine angle associated with vestibularschwannomas(acoustic neuromas):a retro-spective study of1006 consecutive cases. J Neurosurg,2000,92(11):70-78., http://www.100md.com(李晓东 王 潼 常志田)
6.1 术前其他治疗 伽玛刀治疗,放射治疗,化疗等也是影响手术难度的一个重要因素。
6.2 术前面神经损伤程度
6.3 手术医生的体力和耐力 大型听神经瘤显微手术全切并保留面神经功能,不仅是对神经外科医生技术的考验而且也是体力和耐力的考验。
总之,很多因素影响听神经瘤术后面神经功能,我们要充分利用显微神经外科技术,遵循合理的手术策略,配合术中神经电生理监测以提高听神经瘤全切率和面神经保留率。如果听神经瘤做到早发现,早诊断,在面神经没有离断或严重受压变形,血供没有受影响时,利用娴熟的显微外科技术积极手术治疗,将为进一步提高面神经功能保留率提供更大可能。
参 考 文 献
, 百拇医药
[1] Utermark T, Kaempchen K, Hanemann CO. Pathological adhesion of primary human schwannoma cells is dependent on altered expression of integrins.Brain Pathol,2003,13(3);352-363.
[2] Grant GA, Rostomily RR, Kim DK, et al. Delayed facial palsy after resection of vestibular schwannoma. J Neurosurgery,2002, 97(1):93-96.
[3] McElveen JT Jr,Belmonte G, Fukushima T, et al.A review of facial nerve outcome in 100 consecutive cases of acoustic tumor surgery.Laryngoscope,2000,110(10)1667-1672.
, http://www.100md.com
[4] Gormly WB, Sekhar LN, Wright DC,et al.Acoustic neuromas:results of current surgical management.Neurosurgery,1997,41(1):50-58.
[5] House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head neck surg,1985,93(2):146-147.
[6] Sampath P, Holliday MJ, Brem H, et al.Facial nerve injury in acoustic neuroma(restibalar schwannoma) surgery:etiology and prevention.J Neurosurg,1997,87:60-66.
, http://www.100md.com
[7] 于春江,王忠诚,关树深,等.听神经瘤切除面神经保留技术探讨.中华神经外科杂志,2001,17:174-177.
[8] Mari K, A tsunobu T, A tsushi K, et al. Distance From Acoustic Neuroma to Fundus and a Postope rative Facial Palsy. The La ryngoscope,2002,112 (1):168-171.
[9] 李龄.听神经瘤治疗现状.中华神经外科杂志,2000,16(增刊):108-110.
[10] Zhang X,Fei Z,Fu LA,et al. Microsurgical management oflarge acoustic neuromas. Chin J Neurosurg Dis Res,2004,3 (1):25-29.
, 百拇医药
[11] Goldbrunner RH, Schlake HP, Milew ski C, et al. Quantitative parameters of in traoperative electromyography predict facial nerve outcomes for vestiblarschwannoma surgery. Neurosurgery,2000,46(5):1140-1148.
[12] Yamakami I, Uchino Y, kobayashi E, et al. Removel of large acoustic no mortality and minimal morbidity. J Neurol neurosurg Psychiatry,2004,75(3):453-458.
[13] Samii M, Mat t hies C. Management of 1000 vestibulschwannomas(acoustic neuromas):t he facial nerve presevation and restitution of function. Neurosurgery,1997,40(4):684-694.
, 百拇医药
[14] Skrivan J,Zverina E,Bet ka J,et al. Our surgical experiencwit h large vestibular schwannomas. Otolaryngol Pol.2004,58 (1):69-72.
[15] Collet ti V, Fiorino F, Policante Z, et al. Int raoperativemonitoring of facial nerve antidromic potentials during acoustic neuroma surgery. Acta Otolaryngol,1997,117(5):663-669.
[16] Sampath P,Rini D,Long DM. Microanatomical variations inthecerebellopontine angle associated with vestibularschwannomas(acoustic neuromas):a retro-spective study of1006 consecutive cases. J Neurosurg,2000,92(11):70-78., http://www.100md.com(李晓东 王 潼 常志田)