岩静脉保护在听神经瘤手术中的临床意义
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摘要
目的：探讨听神经瘤手术中岩静脉保护的临床意义。
方法：以2009年1月-2011年7月施行的听神经瘤显微手术患者共149例为观察对象。详细回顾研究了岩静脉未保留的患者临床资料特点。采用回顾性研究方法分析对比了岩静脉保留组和未保留组的患者临床资料。同时回顾性研究了听神经瘤术后再次后颅窝减压的7例患者的临床资料特点。
结果：149例患者中岩静脉保留完整141例,保留率达94.6%。
岩静脉未能保留患者(以下简称前者)平均年龄为43.5岁,岩静脉保留患者(以下简称后者)平均年龄46岁；前者男女各4例,后者男性50例,女性84例；前者病程平均6.8年,后者病程平均3.8年；前者肿瘤最大径平均46mm,后者肿瘤最大径平均38.6mm；前者肿瘤囊性变为主者仅1例,后者肿瘤囊性变为主有27例。前者术后复查见术区血肿发生为(4/8),小脑水肿发生为(5/8),小脑出血发生为(3/8),1例患者行后颅窝减压。无患者行侧脑室外引流,术后平均住院14天；后者术后复查发现术区血肿40例,小脑水肿56例,小脑出血12例,行后颅窝减压6例,行脑室外引流2例,术后平均住院天数10.6天。
统计分析两组之间在发生术区血肿和小脑水肿的几率无显著性差异。统计分析显示岩静脉保留组和未保留组的小脑出血发生率有显著性差异。多因素分析显示岩静脉保留是缩短住院天数的保护性因素。
后颅窝减压的7例患者平均年龄为47.6岁,男3例女4例,病程平均4.0年,肿瘤最大径平均40.7mm,肿瘤囊性变为主者0例。术后复查见术区血肿发生为(6/7),小脑水肿发生为(7/7),小脑出血发生为(5/7)。6例患者岩静脉保留。术后平均住院14天。
结论：在听神经瘤手术中,应尽可能对岩静脉进行良好的保护,在目前显微外科技术条件下可以得到良好的保护。保护好岩静脉可能减少小脑出血的发生几率,同时可能会缩短术后住院时间。
一旦未能保留岩静脉,手术中及时扩大缝合硬脑膜甚至敞开硬脑膜,扩大骨窗减压,若小脑外侧份肿胀明显伴挫伤,可考虑切除部分外侧小脑减压,手术后严密观察病情变化,积极做好再次后颅窝减压的准备。
听神经瘤术后再次行后颅窝减压的主要原因是小脑出血、术区血肿和小脑水肿。建议后颅窝减压指征应适当放宽,才可能减少后颅窝高压引起的枕骨大孔疝致患者突发呼吸停止的死亡。预防措施则是术中注意保护小脑引流静脉和小脑组织,手术结束时彻底止血,术后常规复查CT争取第一时间发现异常。
Objective:To investigate the clinical significance of the protection of petrosal vein in the acoustic neuroma surgery.
Methods:From January2009to July2011, a total of149acoustic neuroma microsurgical cases were observed. Detail characteristics of clinical data with the petrosal vein without retained cases were reviewed. The retrospective study compared the characteristics of clinical data of petrosal vein without retention group with retention group. Retrospective study of characteristics of clinical data of whom performed second posterior fossa decompression after acoustic neuroma microsurgery were conducted.
Results:149patients with intact petrosal vein in141cases, the retained rate of94.6%.
Petrosal vein failed to retain patients (hereinafter referred to as the former), the average age of43.5years, petrosal vein to retain patients (hereinafter referred to as the latter), mean age46years; four cases of the former men and women, the latter50cases of male, female84cases; the former course of the disease with an average of6.8years, the latter course of disease with an average of3.8years; the former tumor average diameter of46mm, the latter tumor size average of38.6mm; only one case of the former tumor cystic mainly,27cases of the latter tumors cystic mainly. Reexamination after the operation former see cerebelepontine angle(CPA) hematoma occurred (4/8), cerebellar edema (5/8), cerebellar hemorrhage (3/8),1patient underwent posterior fossa decompression. No patient with lateral ventricle drainage, postoperative hospital stay of14days; the latter found after the surgery CPA hematoma40cases, and cerebellar edema in56cases and cerebellar hemorrhage in12cases,6cases performed posterior fossa decompression, lateral ventricular drainage two cases, the average postoperative length of hospital stay was10.6days.
The statistical analysis between the two groups there was no significant difference in the probability of occurrence of CPA hematoma and cerebellar edema. The statistical analysis show there was significant difference of the incidence of cerebellar hemorrhage between petrosal vein retention group and without retain group. Multivariate analysis show petrosal vein reservation was a protective factor for shorter hospital stay.
Posterior fossa decompression in seven cases with an average age of47.6years,3males and4females, average disease duration of4.0years, an average of40.7mm maximum tumor size, no cystic tumor. After operation CPA hematoma occured (6/7), cerebellar edema (7/7), cerebellar hemorrhage (5/7). Six cases of patients with petrosal vein reserved. The mean postoperative hospital stay was14days.
Conclusion:In acoustic neuroma surgery, the petrosal vein should be well protected under current microsurgical techniques. Protect the petrosal vein may reduce the risk of cerebellar hemorrhage. Also May shorten the postoperative hospital stay.
Once the failure to retain the petrosal vein, the timely expansion of the sutured dura after surgery or even open the dura, to expand the bone window for decompression, if the cerebellum swelling significantly associated with contusion, removal of part of the lateral cerebellar for decompression may be considered, intensive observed after surgery, and actively prepared for second posterior fossa decompression.
The postoperation decompression of posterior fossa in acoustic neuroma cases were mainly due to cerebellar hemorrhage, CPA hematoma and cerebellar edema. Proposed the indications of posterior cranial fossa decompression should be appropriate to widen, as the high pressure in posterior fossa could cause the urgent foramen magnum hernia lead to sudden respiratory arrest which may cause sudden death of patients. Precautionary measures to protect cerebellar draining veins and cerebellum tissue, and intraoperative complete hemostasis, also postoperative routine CT scan could discover abnormality timely.
方法：以2009年1月-2011年7月施行的听神经瘤显微手术患者共149例为观察对象。详细回顾研究了岩静脉未保留的患者临床资料特点。采用回顾性研究方法分析对比了岩静脉保留组和未保留组的患者临床资料。同时回顾性研究了听神经瘤术后再次后颅窝减压的7例患者的临床资料特点。
结果：149例患者中岩静脉保留完整141例,保留率达94.6%。
岩静脉未能保留患者(以下简称前者)平均年龄为43.5岁,岩静脉保留患者(以下简称后者)平均年龄46岁；前者男女各4例,后者男性50例,女性84例；前者病程平均6.8年,后者病程平均3.8年；前者肿瘤最大径平均46mm,后者肿瘤最大径平均38.6mm；前者肿瘤囊性变为主者仅1例,后者肿瘤囊性变为主有27例。前者术后复查见术区血肿发生为(4/8),小脑水肿发生为(5/8),小脑出血发生为(3/8),1例患者行后颅窝减压。无患者行侧脑室外引流,术后平均住院14天；后者术后复查发现术区血肿40例,小脑水肿56例,小脑出血12例,行后颅窝减压6例,行脑室外引流2例,术后平均住院天数10.6天。
统计分析两组之间在发生术区血肿和小脑水肿的几率无显著性差异。统计分析显示岩静脉保留组和未保留组的小脑出血发生率有显著性差异。多因素分析显示岩静脉保留是缩短住院天数的保护性因素。
后颅窝减压的7例患者平均年龄为47.6岁,男3例女4例,病程平均4.0年,肿瘤最大径平均40.7mm,肿瘤囊性变为主者0例。术后复查见术区血肿发生为(6/7),小脑水肿发生为(7/7),小脑出血发生为(5/7)。6例患者岩静脉保留。术后平均住院14天。
结论：在听神经瘤手术中,应尽可能对岩静脉进行良好的保护,在目前显微外科技术条件下可以得到良好的保护。保护好岩静脉可能减少小脑出血的发生几率,同时可能会缩短术后住院时间。
一旦未能保留岩静脉,手术中及时扩大缝合硬脑膜甚至敞开硬脑膜,扩大骨窗减压,若小脑外侧份肿胀明显伴挫伤,可考虑切除部分外侧小脑减压,手术后严密观察病情变化,积极做好再次后颅窝减压的准备。
听神经瘤术后再次行后颅窝减压的主要原因是小脑出血、术区血肿和小脑水肿。建议后颅窝减压指征应适当放宽,才可能减少后颅窝高压引起的枕骨大孔疝致患者突发呼吸停止的死亡。预防措施则是术中注意保护小脑引流静脉和小脑组织,手术结束时彻底止血,术后常规复查CT争取第一时间发现异常。
Objective:To investigate the clinical significance of the protection of petrosal vein in the acoustic neuroma surgery.
Methods:From January2009to July2011, a total of149acoustic neuroma microsurgical cases were observed. Detail characteristics of clinical data with the petrosal vein without retained cases were reviewed. The retrospective study compared the characteristics of clinical data of petrosal vein without retention group with retention group. Retrospective study of characteristics of clinical data of whom performed second posterior fossa decompression after acoustic neuroma microsurgery were conducted.
Results:149patients with intact petrosal vein in141cases, the retained rate of94.6%.
Petrosal vein failed to retain patients (hereinafter referred to as the former), the average age of43.5years, petrosal vein to retain patients (hereinafter referred to as the latter), mean age46years; four cases of the former men and women, the latter50cases of male, female84cases; the former course of the disease with an average of6.8years, the latter course of disease with an average of3.8years; the former tumor average diameter of46mm, the latter tumor size average of38.6mm; only one case of the former tumor cystic mainly,27cases of the latter tumors cystic mainly. Reexamination after the operation former see cerebelepontine angle(CPA) hematoma occurred (4/8), cerebellar edema (5/8), cerebellar hemorrhage (3/8),1patient underwent posterior fossa decompression. No patient with lateral ventricle drainage, postoperative hospital stay of14days; the latter found after the surgery CPA hematoma40cases, and cerebellar edema in56cases and cerebellar hemorrhage in12cases,6cases performed posterior fossa decompression, lateral ventricular drainage two cases, the average postoperative length of hospital stay was10.6days.
The statistical analysis between the two groups there was no significant difference in the probability of occurrence of CPA hematoma and cerebellar edema. The statistical analysis show there was significant difference of the incidence of cerebellar hemorrhage between petrosal vein retention group and without retain group. Multivariate analysis show petrosal vein reservation was a protective factor for shorter hospital stay.
Posterior fossa decompression in seven cases with an average age of47.6years,3males and4females, average disease duration of4.0years, an average of40.7mm maximum tumor size, no cystic tumor. After operation CPA hematoma occured (6/7), cerebellar edema (7/7), cerebellar hemorrhage (5/7). Six cases of patients with petrosal vein reserved. The mean postoperative hospital stay was14days.
Conclusion:In acoustic neuroma surgery, the petrosal vein should be well protected under current microsurgical techniques. Protect the petrosal vein may reduce the risk of cerebellar hemorrhage. Also May shorten the postoperative hospital stay.
Once the failure to retain the petrosal vein, the timely expansion of the sutured dura after surgery or even open the dura, to expand the bone window for decompression, if the cerebellum swelling significantly associated with contusion, removal of part of the lateral cerebellar for decompression may be considered, intensive observed after surgery, and actively prepared for second posterior fossa decompression.
The postoperation decompression of posterior fossa in acoustic neuroma cases were mainly due to cerebellar hemorrhage, CPA hematoma and cerebellar edema. Proposed the indications of posterior cranial fossa decompression should be appropriate to widen, as the high pressure in posterior fossa could cause the urgent foramen magnum hernia lead to sudden respiratory arrest which may cause sudden death of patients. Precautionary measures to protect cerebellar draining veins and cerebellum tissue, and intraoperative complete hemostasis, also postoperative routine CT scan could discover abnormality timely.
引文
[1]Dandy WE:An operation for the cure of tic douloureux.Partial section of the sensory root at the pons. Arch Surg[J] 18:687-734,1929
[2]Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg[J] 1934; 24:447-455.
[3]Matsushima T, Rhoton Jr AL, de Oliveira E, et al. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg[J] 1983;59:63-105.
[4]Rhoton Jr AL. Microsurgical anatomy of acoustic neuromas. Neurol Res[J] 1984;6:3-21.
[5]Strauss C, Naraghi R, Bischoff B, et al. Contralateral hearing loss as an effect of venous congestion at the ipsilateral inferior colliculus after microvascular decompression:report a case. J Neurol Neurosurg Psychiatry[J] 2000;69:679-82.
[6]McLaughlin MR, Jannetta PJ, Clyde BL, et al. Microvascular decompression of cranial nerves:lessons learned after 4400 operations. J Neurosurg [J] 1999;90:1-8.
[7]Strauss C, Neu M, Bischoff B, et al. Clinical and neurophysiological observations after superior petrosal vein obstruction duringsurgery of the cerebellopontine angle:case report. Neurosurgery [J] 2001; 48:1157-9.
[8]Gharabaghi A, Koerbel A, Lo"wenheim H, et al. The impact of petrosal vein preservation on postoperative auditory function in surgery of petrous apex meningiomas. Neurosurgery [J] 2006;59(1 Suppl. 1):ONS68-74.
[9]Koerbel A., Gharabaghi A., Safavi-Abbasi S., et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. European Journal of Surgical Oncology[J],2009,35:773-779.
[10]奚健,袁贤瑞,王君宇,等.听神经瘤手术中岩静脉的保护及其意义.中华神经外科杂志[J],2009,25(4)：301-303
[11]Padget DH:The development of the cranial venous system in man, from the viewpoint of comparative anatomy. Contrib Embryo[J] 136:79-140,1957.
[12]Albert L, Rhoton. The posterior fossa veins. Neurosurgery [J],2000, Supplement:69-92.
[13]李光华,梁继锋,王美荣,等.岩静脉的显微外科解剖及其临床意义.中国耳鼻咽喉颅底外科杂志[J],1998,4：138-140.
[14]张继志,段云平,高宝山,等.岩静脉的显微解剖研究及术中处理.中国微创外科杂志[J],2008,8(8)：713-715.
[15]陈国强,李锐,郭京.三叉神经痛微血管减压术导致患者死亡的手术并发症.立体定向和功能性神经外科杂志[J],2004,17(1)：44-46.
[16]Schmidek & Sweet. Operative Neurosurgical Technique:Indications, Methods and Results.4th edition.[M] W. B. Saunders Company, USA:Philadelphia,2000: 1508-1510.
[17]Inamasu J, Shiobara R, Kawase T, et al. Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery:A report of two cases. Eur Arch Otorhinolaryngol[J],2002,259:162-165.
[18]焦迎斌,丰育功.微血管减压术中岩静脉切断的可行性研究.中国临床神经外科杂志[J],2007,12(10)：610-613.
[19]赵卫国,濮春华,李宁,等.三叉神经痛的病因诊断和显微手术治疗(附238例报告).中华神经外科杂志[J],2006,22(11)：681-683.
[20]陈立华,刘运生,袁贤瑞,等.大型听神经瘤的显微手术治疗.中华显微外科杂志[J],2002,25(4)：267-270.
[21]罗世祺,马振宇.大型听神经瘤的手术治疗.中华神经外科杂志[J],1996,12(2)：96-99.
[22]魏学忠,许在华,薛洪利.显微手术治疗听神经瘤126例.中华神经外科杂志[J],2000,16(5)：295-297.
[23]王多斌,张跃康.显微手术切除巨大听神经瘤策略、技巧及相关并发症的处理[J].华西医学,2007,22(1)：2-3.
[24]丁学华,卢亦成,秦时强.大型听神经瘤手术并发症及其预防.中国临床神经外科杂志[J],2003,8(2)：81-84.
[25]卞杰勇,王中,周幽心,等.乙状窦后桥小脑角手术并发症的防治(附109例报告).苏州大学学报(医学版)[J],2007,27(2)：250-252.
[26]于春江,王忠诚,关树森,等.听神经瘤切除面神经保留技术探讨.中华神经外科杂志[J],2001,17(3)：174-177.
[27]徐庚,叶明,凌锋.桥小脑角及斜坡肿瘤手术并发症的原因分析.中华神经外科杂志[J],2005,21(12)：736-738.
[28]F.H. Ebner a, F. Roser a, T. Shiozawa b, et al. Petrosal vein occlusion in cerebello-pontine angle tumour surgery:An anatomical study of alternative draining pathways. EJSO[J] 35 (2009) 552-556.
[1]Samii M, Matthies C. Management of 1,000 vestibular schwannomas (acoustic neuromas):Surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery[J] 1997;40:11-23.
[2]Sanna M, Taibah A, Russo A, et al. Perioperative complications (vestibula r schwannoma) surgery. Otol Neurotol[J] 2004;25:379-386.
[3]Deveze A, Roche PH, Facon F, et al. Resultats de l'exerese par voie translabyrinthique elargie des schwannomes vestibulaires. Neurochirurgie[J] 2004;50:244-252.
[4]Kanzaki J, Ogawa K, Tsuchihashi N,et al.Perioperative complications in acoustic neuroma surgery by the extended middle cranial fossa approach. Acta Otolaryngol Suppl[J] 1991;487:75-79.
[5]Sade B, Mohr G, Dufour JJ.Vascular complications of vestibular schwannoma surgery:a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg[J] 2006;105:200-204.
[6]Sluyter S, Graamans K, Tulleken CAF,et al. Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach. J Neurosurg[J] 2001;94:61-66.
[7]Briggs RJS, Luxford WM, Atkins JS, et al. Translabyrinthine removal of large acoustic neuromas.Neurosurgery[J] 1994;34:785-792.
[8]Yamakami I, Uchino Y, Kobayashi E,et al.Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neural Neurosurg Psychiatry[J] 2004;75:433-458.
[9]Kania R, Lot G, Herman P, et al. Vascular complications after acoustic neurinoma surgery. Ann Otolaryngol Chir Cervicofac[J] 2003;120:94-102.
[10]Keiper GL, Sherman JD, Tomsick TA, et al.Dural sinus thrombosis and psudotumor cerebri:unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg[J] 1999;91:192-197.
[11]Rodgers GK, Luxford WM. Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. Laryngoscope [J] 1993; 103:959-962.
[12]Brennan JW, Rowed DW, Nedzelski JM, et al. Cerebrospinal fluid leak after acoustic neuroma surgery:Influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg[J] 2001;94:217-223.
[13]Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery:a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol[J] 2003;24:107-112.
[14]Tanaka Y, Kobayashi S, Hongo K,et al.Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg[J] 2003;98:1118-1193.
[15]Duke DA, Lynch JJ, Harner SG,et al. Venous air embolism in sitting and supine patients undergoing vestibular schwannoma resection. Neurosurgery[J] 1998;42: 1282-1286.
[16]Shao KN, Tatagiba M, Samii M. Surgical management of high jugular bulb in acoustic neurinoma via retrosigmoid approach. Neurosurgery[J] 1993;32:32-37.
[17]Kim HH, Johnston R, Wiet RJ, et al. Long-term effects of cerebellar retraction in the microsurgical resection of vestibular schwannomas.Laryngoscope[J] 2004;114:323-326.
[18]Ohata K, Haque M, Morino M,et al.Occlusion of the sigmoid sinus aftersurgery via the presigmoidal-transpetrosal approach. J Neurosurg[J] 1998;89:575-584.
[2]Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg[J] 1934; 24:447-455.
[3]Matsushima T, Rhoton Jr AL, de Oliveira E, et al. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg[J] 1983;59:63-105.
[4]Rhoton Jr AL. Microsurgical anatomy of acoustic neuromas. Neurol Res[J] 1984;6:3-21.
[5]Strauss C, Naraghi R, Bischoff B, et al. Contralateral hearing loss as an effect of venous congestion at the ipsilateral inferior colliculus after microvascular decompression:report a case. J Neurol Neurosurg Psychiatry[J] 2000;69:679-82.
[6]McLaughlin MR, Jannetta PJ, Clyde BL, et al. Microvascular decompression of cranial nerves:lessons learned after 4400 operations. J Neurosurg [J] 1999;90:1-8.
[7]Strauss C, Neu M, Bischoff B, et al. Clinical and neurophysiological observations after superior petrosal vein obstruction duringsurgery of the cerebellopontine angle:case report. Neurosurgery [J] 2001; 48:1157-9.
[8]Gharabaghi A, Koerbel A, Lo"wenheim H, et al. The impact of petrosal vein preservation on postoperative auditory function in surgery of petrous apex meningiomas. Neurosurgery [J] 2006;59(1 Suppl. 1):ONS68-74.
[9]Koerbel A., Gharabaghi A., Safavi-Abbasi S., et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. European Journal of Surgical Oncology[J],2009,35:773-779.
[10]奚健,袁贤瑞,王君宇,等.听神经瘤手术中岩静脉的保护及其意义.中华神经外科杂志[J],2009,25(4)：301-303
[11]Padget DH:The development of the cranial venous system in man, from the viewpoint of comparative anatomy. Contrib Embryo[J] 136:79-140,1957.
[12]Albert L, Rhoton. The posterior fossa veins. Neurosurgery [J],2000, Supplement:69-92.
[13]李光华,梁继锋,王美荣,等.岩静脉的显微外科解剖及其临床意义.中国耳鼻咽喉颅底外科杂志[J],1998,4：138-140.
[14]张继志,段云平,高宝山,等.岩静脉的显微解剖研究及术中处理.中国微创外科杂志[J],2008,8(8)：713-715.
[15]陈国强,李锐,郭京.三叉神经痛微血管减压术导致患者死亡的手术并发症.立体定向和功能性神经外科杂志[J],2004,17(1)：44-46.
[16]Schmidek & Sweet. Operative Neurosurgical Technique:Indications, Methods and Results.4th edition.[M] W. B. Saunders Company, USA:Philadelphia,2000: 1508-1510.
[17]Inamasu J, Shiobara R, Kawase T, et al. Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery:A report of two cases. Eur Arch Otorhinolaryngol[J],2002,259:162-165.
[18]焦迎斌,丰育功.微血管减压术中岩静脉切断的可行性研究.中国临床神经外科杂志[J],2007,12(10)：610-613.
[19]赵卫国,濮春华,李宁,等.三叉神经痛的病因诊断和显微手术治疗(附238例报告).中华神经外科杂志[J],2006,22(11)：681-683.
[20]陈立华,刘运生,袁贤瑞,等.大型听神经瘤的显微手术治疗.中华显微外科杂志[J],2002,25(4)：267-270.
[21]罗世祺,马振宇.大型听神经瘤的手术治疗.中华神经外科杂志[J],1996,12(2)：96-99.
[22]魏学忠,许在华,薛洪利.显微手术治疗听神经瘤126例.中华神经外科杂志[J],2000,16(5)：295-297.
[23]王多斌,张跃康.显微手术切除巨大听神经瘤策略、技巧及相关并发症的处理[J].华西医学,2007,22(1)：2-3.
[24]丁学华,卢亦成,秦时强.大型听神经瘤手术并发症及其预防.中国临床神经外科杂志[J],2003,8(2)：81-84.
[25]卞杰勇,王中,周幽心,等.乙状窦后桥小脑角手术并发症的防治(附109例报告).苏州大学学报(医学版)[J],2007,27(2)：250-252.
[26]于春江,王忠诚,关树森,等.听神经瘤切除面神经保留技术探讨.中华神经外科杂志[J],2001,17(3)：174-177.
[27]徐庚,叶明,凌锋.桥小脑角及斜坡肿瘤手术并发症的原因分析.中华神经外科杂志[J],2005,21(12)：736-738.
[28]F.H. Ebner a, F. Roser a, T. Shiozawa b, et al. Petrosal vein occlusion in cerebello-pontine angle tumour surgery:An anatomical study of alternative draining pathways. EJSO[J] 35 (2009) 552-556.
[1]Samii M, Matthies C. Management of 1,000 vestibular schwannomas (acoustic neuromas):Surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery[J] 1997;40:11-23.
[2]Sanna M, Taibah A, Russo A, et al. Perioperative complications (vestibula r schwannoma) surgery. Otol Neurotol[J] 2004;25:379-386.
[3]Deveze A, Roche PH, Facon F, et al. Resultats de l'exerese par voie translabyrinthique elargie des schwannomes vestibulaires. Neurochirurgie[J] 2004;50:244-252.
[4]Kanzaki J, Ogawa K, Tsuchihashi N,et al.Perioperative complications in acoustic neuroma surgery by the extended middle cranial fossa approach. Acta Otolaryngol Suppl[J] 1991;487:75-79.
[5]Sade B, Mohr G, Dufour JJ.Vascular complications of vestibular schwannoma surgery:a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg[J] 2006;105:200-204.
[6]Sluyter S, Graamans K, Tulleken CAF,et al. Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach. J Neurosurg[J] 2001;94:61-66.
[7]Briggs RJS, Luxford WM, Atkins JS, et al. Translabyrinthine removal of large acoustic neuromas.Neurosurgery[J] 1994;34:785-792.
[8]Yamakami I, Uchino Y, Kobayashi E,et al.Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neural Neurosurg Psychiatry[J] 2004;75:433-458.
[9]Kania R, Lot G, Herman P, et al. Vascular complications after acoustic neurinoma surgery. Ann Otolaryngol Chir Cervicofac[J] 2003;120:94-102.
[10]Keiper GL, Sherman JD, Tomsick TA, et al.Dural sinus thrombosis and psudotumor cerebri:unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg[J] 1999;91:192-197.
[11]Rodgers GK, Luxford WM. Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. Laryngoscope [J] 1993; 103:959-962.
[12]Brennan JW, Rowed DW, Nedzelski JM, et al. Cerebrospinal fluid leak after acoustic neuroma surgery:Influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg[J] 2001;94:217-223.
[13]Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery:a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol[J] 2003;24:107-112.
[14]Tanaka Y, Kobayashi S, Hongo K,et al.Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg[J] 2003;98:1118-1193.
[15]Duke DA, Lynch JJ, Harner SG,et al. Venous air embolism in sitting and supine patients undergoing vestibular schwannoma resection. Neurosurgery[J] 1998;42: 1282-1286.
[16]Shao KN, Tatagiba M, Samii M. Surgical management of high jugular bulb in acoustic neurinoma via retrosigmoid approach. Neurosurgery[J] 1993;32:32-37.
[17]Kim HH, Johnston R, Wiet RJ, et al. Long-term effects of cerebellar retraction in the microsurgical resection of vestibular schwannomas.Laryngoscope[J] 2004;114:323-326.
[18]Ohata K, Haque M, Morino M,et al.Occlusion of the sigmoid sinus aftersurgery via the presigmoidal-transpetrosal approach. J Neurosurg[J] 1998;89:575-584.