摘要目的 探讨不同类型复发听神经瘤的临床特征及其显微外科手术治疗方法.方法 回顾性分析2010年1月至2016年10月华中科技大学同济医学院附属同济医院神经外科收治的29例复发听神经瘤患者的临床资料.初次手术全切除后复发11例(全切复发组),初次不全切除后复发18例(非全切复发组).比较两组患者的年龄、原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变、两次手术间隔时间、并发症、House-Brackmann面神经功能分级(H-B分级).结果 全切复发组的平均年龄大于非全切复发组[分别为(52.2±10.8)岁和(33.0±5.5)岁,P＜0.05],前者两次手术间隔时间也明显大于后者[分别为(93.3±30.0)个月和(45.0±15.6)个月,P＜0.001].两组的原发肿瘤最大径、复发肿瘤最大径、肿瘤囊性变的比率、并发症发生率、面神经功能良好(H-B分级Ⅰ、Ⅱ级)比率的差异均无统计学意义(均P＞0.05).29例患者的随访时间为3～37个月,平均(11.7±3.1)个月.肿瘤全切除28例,近全切除1例.术中面神经解剖保留率为93％ (27/29).术后实用听力保留率为7％ (2/29),面神经功能良好的比率为41％ (12/29).结论 听神经瘤不全切除后残留复发者的两次手术间隔时间明显较全切除者短.在保护神经功能的前提下,初次全切除是听神经瘤患者获得最佳临床疗效的首选方法.对于复发听神经瘤建议早期积极手术.

abstractsObjective To investigate clinical features and surgical treatment of various types of recurrent acoustic neuromas.Methods The clinical data of 29 patients with recurrent acoustic neuromas were analyzed retrospectively who were admitted to Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2010 to October 2016.Those cases recurring following primary total removal were classified as total resection relapse group (11 cases) and those recurring after incomplete resection were classified as non-total resection relapse group (18 cases).Multiple parameters were compared including the mean age,the mean maximal diameter of primary and recurrent tumors,cystic/solid ratio,re-operation interval,postoperative complication,facial nerve function (House-Brackmann facial nerve function grading system) between the two groups.Results The mean age in the total resection relapse group was higher than that in non-total resection relapse group (52.2 ± 10.8 years vs.33.0 ± 5.5 years,P ＜ 0.05),and the mean re-operation interval of the former is greater than that of the latter (93.3 ± 30.0 months vs.45.0 ± 15.6 months,P ＜0.001).There was no difference in the mean maximal diameter of primary or recurrent tumor,cystic/solid ratio,complication rate,reservation rate of good facial nerve function between the two groups (all P ＞ 0.05).The follow-up time of 29 cases ranged from 3 to 37 months,and the mean follow-up time was 11.7 ± 3.1 months.Among them,the tumors in 28 cases were totally removed and the remaining 1 case underwent near-total resection.The facial nerves were anatomically preserved in 27 cases (93％,27/29),and the practical hearing was preserved in 2 cases (7％,2/29).The good reservation rate of facial nerve function was 41％ (12/29).Conclusions The mean re-operation interval after incomplete removal of acoustic neuroma is significantly shorter than that following total removal.In terms of preservation of neurological function,total resection of tumors in primary operation seems to be optimal for patients.Early surgery might be suggested for recurrent acoustic neuromas.