【摘要】 目的 比较手术及伽马刀治疗lt;3 cm听神经瘤的优劣。 方法 由2名研究人员分别检索1990年1月1日—2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文，选择证据级别最高的文献，使用Cochrane图书馆提供的RevMan 5.0软件，对手术和伽马刀治疗小型听神经瘤在面神经、听力功能保留的优劣方面进行Meta分析。 结果 共检索到4篇前瞻性队列研究，排除2篇。剩余的2篇文献共纳入患者173例，分析发现，在1年随访及随访结束时，手术治疗组与伽马刀治疗组相比，在面神经功能完整保留方面，P值及其95%CI分别为0.64（0.53，0.77）、0.67（0.47，0.96）；在保留有用听力方面，P值及其95%CI分别为0.08（0.02，0.27）及0.08（0.02，0.28）。 结论 伽马刀治疗lt;3 cm的听神经瘤，无论在保留有用听力还是面神经功能方面均明显优于手术。【Abstract】 Objective To compare surgery and gamma-knife treatment in treating acoustic neuroma less than 3 cm in diameter through Meta analysis. Methods Two researchers respectively searched relevant papers from such databases as CENTRAL, ISI, Medline, Embase, NLM Gateway, and CBMdisc posted on the online library of Sichuan University. Papers with the highest-grade evidence were selected, and RevMan 5.0 provided by Cochrane Library was used to compare surgery and gamma-knife treatment in the preservation of patients’ facial nerves and useful hearing through Meta analysis. Results Four prospective cohort studies were found, two of which were excluded. The remaining two articles were analyzed, and we compared surgery and gamma-knife treatment during the 1-year and the last follow-up period in facial nerve preservation and useful hearing preservation. The P value and 95% CI of the comparison was respectively 0.64 (0.53, 0.77) and 0.67 (0.47, 0.96) for facial nerve preservation, and 0.08 (0.02, 0.27) and 0.08 (0.02, 0.28) for useful hearing preservation. Conclusion Gamma-knife treatment for acoustic neuroma less than 3 cm in diameter is a much better choice than surgery in preserving hearing and facial nerve function.
目的 探讨显微切除延髓实体性血管母细胞瘤术中电生理监测的意义。 方法 2007年7月-2009年8月，在电生理监测下显微切除13例延髓实体性血管母细胞瘤，观察切除程度、死亡率及术后脑干功能，并对电生理监测下的手术技巧进行讨论总结。 结果 完全切除13例延髓实体性血管母细胞瘤，术后因呼吸功能衰竭死亡1例，6个月脑干机能状态较术前保持或改进10例。 结论 延髓实体性血管母细胞瘤切除术中行神经电生理监测有助于提高手术效果，改善预后。
To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.