修正式經乙狀竇後之前庭神經截斷術

Modified Retrosigmoid Vestibular Neurectomy

鍾從得(Tsung-Te Chung) ； 洪嘉駿(Chia-Chun Hung)

《台灣耳鼻喉頭頸外科雜誌》 39卷6期 (2004/12) Pp. 242-248

https://doi.org/10.6286/2004.39.6.242

摘要

背景：前庭神經截斷術，是治療梅尼爾氏病頑固性眩暈的手術方式。其手術之途徑常被使用的有乙狀竇後、迷路後、合併迷路後乙狀竇等3種。乙狀竇後途徑，需拉鉤壓迫小腦，可能造成受傷，且耳科醫師不易獨立操作。另二種途徑都需切開乳突，增加腦脊髓液外漏機會，且需取腹部脂肪，會造成病人術後腹部不適。希望改良方法，以減少此3種路徑之缺點。
方法：先做枕骨開顱，磨開部位較乙狀竇後途徑較前方，再磨開乙狀竇後半部，不做乳突切開術。腦膜切開處位乙狀竇後3mm，不需拉鉤壓迫小腦，可清楚暴露小腦橋腦角處之第八腦神經。於l997年7月至2002年9月間，12例單側梅尼爾氏病患接受修正式經乙狀竇後之前庭神經截斷術，依病歷記載及電話追蹤做分析。
結果：12例病患由耳科醫師順利完成手術，其眩暈治癒率為92%，聽力保留率為92%。術後沒有顏面神經麻痺、腦膜炎、傷口感染及頭痛現象。僅l例腦脊髓液由傷口外漏，非由乳突處耳漏。
結論：修正式經乙狀竇後之前庭神經截斷術，不需拉鉤壓迫小腦，不做乳突切開，不需取腹部脂肪，耳科醫師可獨立操作。其術後之眩暈治癒率高，不傷害聽力且併發症少。

關鍵字

梅尼爾氏病 ； 修正式經乙狀竇後之前庭神經截斷術

並列摘要

BACKGROUND: Vestibularneurectomy is a surgical method to treat intractable vertigo due to Meniere's disease. This operation is usually performed using one of three approaches-retrosigmoid, retrolabyrinthe or combined retrolab-retrosigmoid. The retrosigmoid approach usually needs cerebellum traction, so it is difficult to do by an otologist alone and there is an increased the chance of cerebellum injury. The other two approaches need mastoidectomy and the removal of abdominal fat, so there is the possibility of cerebrospinal fluid (CSF) leakage and abdominal suffering postoperatively. In trying to modify the operative procedures, the intention was to reduce these disadvantages.
METHO DS: The occipital craniectomy of Modified Retro sigmoid Vestibular Neurectomy (MRSVN) is located anterior to retrosigmoid approach and the posterior half wall of sigmoid sinus is drilled off. There is no need for mastoidectomy, or the removal of abdominal fat. The dura incision is 3mm behind sigmoid sinus and the eighth cranial nerve can be well exposed in the cerebellopontine angle without cerebellum traction. From August 1997 to September 2002, twelve Meniere's disease patients were treated by MRSVN. The results of the operation were analysed through chart records and by telephone follow up.
RESULTS: MRSVN was completed on the 12 patients by an otologist without any problems. Postoperatively, there was no facial palsy, meningitis, wound infection or headache. CSF leakage from the wound, but not from mastoid, occurred in only one case. The vertigo cure rate was 92% and the hearing preservation rate was 92%.
CONCLUSION: MRSVN needs no cerebellar traction, no mastoidectomy or removal of abdominal fat. It involves fewer and easierprocedures, and it has the benefit of a high vertigo cure rate, a high hearing preservation rate and a low complication rate.

並列關鍵字

Meniere's disease ； Modified retrosigmoid vestibular neurectomy