摘要目的 探讨经颅中窝径路切除内听道内小听神经瘤手术对面神经和听神经功能的保护.方法 2004年1月至2013年2月共13例患者接受经颅中窝径路切除内听道内的小听神经瘤,其中男6例,女7例,年龄38 ～ 54岁；瘤体大小为0.8～1.5cm.听神经功能评价根据美国耳鼻咽喉头颈外科学会的标准分为A、B、C、D四级,面神经功能的评估参照House-Brackmann (HB)分级标准,比较患者手术前和手术后1个月时的面听神经功能.结果 13例患者手术顺利,无死亡病例,其中12例患者肿瘤全切,1例近全切除.患者术前听力评估A级10例、B级2例、C级1例,术后复查,2例患者听力由A级下降至B级,1例由B级升至A级,1例由B级下降至C级,术后听力A级保存率为80％(8/10).12例患者术前面神经功能为HB Ⅰ级,术后仍为Ⅰ级,术后面神经功能Ⅰ级保留率为100％(12/12)；1例面神经功能Ⅱ级患者术后下降为Ⅲ级.术后随访0.5～5年,均未出现严重并发症.结论 颅中窝径路内听道内小听神经瘤切除术可有效保留听神经和面神经功能,手术切除可以考虑作为小听神经瘤患者的常规治疗手段.

abstractsObjective The aim of this study was to investigate the heating and facial nerve preservation in the middle fossa approach surgery for the removal of small acoustic tumor (vestibular schwannomas,VS).Methods A prospective database was established,and data were retrospectively reviewed.Between January 2004 and February 2013,13 patients with acoustic tumor underwent surgery via middle fossa approach for heating preservation.The patients consisted of six men and seven women with a mean age of 48 years.Tumor size ranged from 0.8 cm to 1.5 cm.Heating loss was categorized as American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) class A,class B,class C and class D.Facial nerve function was evaluated according to House-Brackmann (HB) Grade Ⅰ-Ⅵ.Results Grosstotal resection was accomplished in 12 of 13 patients.Preoperative heating as class A in ten,class B in two,and class C in one patient respectively.Postoperatively,heating was graded as class A in eight patients,class B in 3,and class C in 2 patients.Facial nerve function was House-Brackmann(HB) grade Ⅰ in twelve patients,grade Ⅱ in one patient preoperatively.Postoperatively,facial nerve function was HB Grade Ⅰ in twelve patients and Grade Ⅲ in one patient.The overall heating preservation rate was at least 80％ (8/10)and HB Grade Ⅰ facial nerve outcome of 100％ (12/12).All cases were followed up for 0.5 to 5 years,no complications were abserved.Conclusions The middle fossa approach for the resection of small VS with heating preservation is a viable and relatively option.It should be considered among the various options available for the management of small and growing VS.