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目的探索耳内镜在侧颅底和桥小脑角手术中的应用价值。方法2004～2008年对6例患者联合应用耳内镜和显微镜下手术治疗,其中2例听神经瘤、1例梅尼埃病患者采用迷路后入路行前庭神经切断术,1例岩尖部炎性肉芽经颅中凹入路;1例岩尖胆脂瘤采用迷路入路;1例颈静脉球体瘤经外耳道入路,比较患者手术前后的听力及面神经功能,纯音听阈取0.5、1、2、4kHz的气导听阈均值,面神经功能的评估按House-Brackmann分级标准。结果所有患者手术顺利,无死亡病例,3例患者肿瘤、1例患者炎性肉芽及1例患者岩尖胆脂瘤均全切。梅尼埃病患者术后眩晕、耳鸣均消失;颈静脉球体瘤患者术后搏动性耳鸣消失,听阈轻度上升;2例听神经瘤患者1例保存了术前听力,另1例术后患耳听力丧失;岩尖胆脂瘤、岩尖炎性肉芽患者术后听力无明显改善。1例听神经瘤术后面神经功能为Ⅱ级,术后1个月为Ⅰ级;另1例术前面神经功能为Ⅱ级,术后6个月仍为Ⅱ级。岩尖胆脂瘤患者术前面神经功能为Ⅵ级,术后6个月仍为Ⅵ级,术后4年为Ⅲ级;其余3例术后面神经功能均为Ⅰ级。结论耳内镜辅助显微镜完成侧颈的及桥小脑角手术有利于拓宽视野,避免损伤正常结构和颅神经,尽可能保存听、面神经的功能。
Objective To explore the value of endoscopic surgery in lateral skull base and bridge cerebellar angle. Methods From 2004 to 2008, 6 patients underwent endoscopic and microscopic surgery. Two patients had acoustic neuroma and one patient with Ménière’s disease underwent posterior vestibular nephrectomy and one petrous apexitis One case of petrous acervical cholesteatoma was translucent; 1 case of jugular bulb tumor by external auditory canal approach, the patient’s hearing and facial nerve function before and after surgery compared to pure tone threshold 0.5,1,2 , 4kHz mean airway hearing threshold, facial nerve function assessment according to House-Brackmann grading standards. Results All the patients underwent surgery successfully with no deaths. The tumors of 3 patients, inflammatory granulation of 1 patient and petrified cholesteatoma of 1 patient were all cut. Patients with Ménière’s disease had dizziness and tinnitus disappeared after operation; patients with jugular bulb tumor disappeared and their threshold increased slightly; one patient with acoustic neuroma had preserved preoperative hearing, and the other one had ear Hearing loss; rock sharp cholesteatoma, rock tip inflammatory granulation patients with no significant improvement in hearing. One case of acoustic neuroma posterior facial nerve function was grade Ⅱ, one month after surgery was grade Ⅰ; the other one case of preoperative nerve function was Ⅱ grade, six months after operation is still Ⅱ grade. The petrified cholesteatoma patients had grade Ⅵ neurovascular function before operation, grade Ⅵ 6 months after surgery and grade Ⅲ 4 years after operation. The function of facial nerve in the other 3 cases was grade Ⅰ. Conclusions Endoscopic assisted microsurgery to complete the lateral neck and bridge cerebellar angle surgery is conducive to broaden the field of vision, to avoid damage to the normal structure and cranial nerves, as much as possible to preserve the function of the auditory and facial nerve.