經中顱窩途徑保留聽力之聽神經瘤手術

Middle Fossa Approach for Hearing Preservation in Acoustic Neuroma Surgery

鍾從得(Tsung-Te Chung) ； 陳建志(Chien-Chih Chen) ； 楊顓謙(Chuan-Chien Yang) ； 蔡定洲(Ting-Chou Tsai) ； 許惇彥(Tun-Yen Hsu) ； 劉德雄(Te-Hsiung Liu)

《台灣耳鼻喉頭頸外科雜誌》 41卷6期 (2006/12) Pp. 191-196

https://doi.org/10.6286/2006.41.6.191

摘要

背景：聽神經瘤手術的理想目標有3個：1.完全摘除腫瘤，2.維持顏面神經功能3.保存可用之聽力。其中以保留聽力最難達成。中顱窩途徑是可保留聽力的手術方式之一，但其解剖標誌不明，相較其他聽神經的手術途徑困難。我們參照主要文獻記載之手術技巧，希望以此手術途徑達成聽力保留之目標。
方法：以颧骨根、大淺岩神經、膝狀神經節或鎚骨頭為解剖標誌，在颧骨根直線延伸處之顳骨最內側磨寬、磨深，可找到內聽道開口處。1999年12月至2005年12月間，5例聽神經瘤經此方法摘取腫瘤，以病歷記載作一回溯性報告及分析。
結果：5例患者成功由此途徑及手術方法進入內聽道及小腦前腦角摘取聽神經瘤。術後聽力得以保留在純聽力優於50dB且語言辨識能力優於50%者之程度者，共有3例；顏面神經功能術後1年恢復至House-Brackmam第1或2級的有4例；5例病人無任何嚴重併發症發生。
結論：經中顱窩途徑把握手術技巧，可達內聽道及小腦橋腦角。以此手術途徑處理小型聽神經瘤，可有效保留聽力，且其術後併發症低。

關鍵字

中顱窩途徑 ； 聽神經瘤 ； 保留聽力

並列摘要

BACKGROUND: The goals in acoustic neuroma surgery are first total removal of tumor, second the maintenance of facial nerve function, and third the preservation of social useful hearing. Among these goals, hearing preservation is the most difficult to achieve.
Middle fossa approach is a surgical method to preserve hearing in acoustic neuroma surgery, but the surgical landmarks are often inconsistent and can be difficult or ambiguous to identify. Following the major article's surgical techniques, the aim of acoustic neuroma removal with hearing preservation is attempted to be achieved.
METHODS: After identifying the zygomatic root, superficial greater petrosal nerve and malleus head, the internal auditory canal was located in a straight line from zygomatic root medially to malleus head.
From December 1999 to December 2005, five acoustic neuroma patients were treated by middle fossa approach. The methods and results of the operation were analysed through chart records.
RESULTS: Five patients' tumors were taken from internal auditory canal and cerebellopontine angle successfully by middle fossa approach. Three patients had hearing acuity better than 50db in pure tone average and 50% in speech discrimination score postoperatively.
Four patients had House-Brachmann level 1 or 2 facial nerve function one year postoperatively. No major complications occurred in 5 patients.
CONCLUSION: Middle fossa approach can access the internal auditory canal and cerebellopontine angle following the consistent landmarks. It is an effective way to preserve hearing in small acoustic neuroma with a low surgical complication rate.

並列關鍵字

middle fossa approach ； acoustic neuroma ； hearing preservation