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听神经瘤的诊断及外科治疗策略
听神经瘤(acoustic neurinoma,AN)是原发于第八颅神经鞘膜上的肿瘤,主要位于前庭神经分支胶质-雪旺鞘膜结合部(glial-schwann sheath junction),故又称前庭神经鞘膜瘤(vestibular schwannoma,VS),占颅内肿瘤的6%~9%,除脑膜瘤、垂体瘤及胶质瘤外居于第4位,占桥小脑角(cerebellopontine angle,CPA)肿瘤的80%~90%[1].
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CT与MR图像融合技术在听神经瘤检查中的初步应用
听神经瘤(acoustic neurinoma)发病率较高~([1]).治疗前的准确定性诊断及病变范围的精确勾画对临床治疗非常重要,影像检查主要依赖CT或MRI,由于CT、MRI对骨质和钙化、软组织的分辨率各有优势,笔者拟将同一患者的CT、MR图像进行融合,探讨CT与MR图像融合技术在听神经瘤检查中的应用价值.
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枕下乙状窦后入路切除听神经鞘瘤并发症的观察与护理
听神经鞘瘤位于后颅窝脑桥小脑角,发病率约占颅内肿瘤的8%~10%.肿瘤生长特点为沿内听道扩展,出内耳门向脑桥小脑角发展,周围解剖关系复杂,是神经外科较复杂的手术之一.经枕下乙状窦后入路,可充分暴露桥小脑角的外、前、上三面及内听道后壁,提高面神经保留率及肿瘤全切率,且损伤相对较小[1].虽然随着显微神经外科手术的推广以及高速微型磨钻的普及,手术效果有明显改善,但由于手术位置较深,手术时可直接或间接影响脑干功能,危险性较大,术后并发症严重,会出现中枢性呼吸、心率、血压的改变及意识障碍等危重情况.现将106例手术并发症情况进行回顾性分析,结果如下.
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X-刀治疗颅内肿瘤115例研究
115 patients with intracranialtumor(128 nidus in total)have been treated by X- knife made in china and 78 patients were followed- up.The short- term effect was satisfying. 1 Subject and method 1.1 Subject 115 patients ,78 male and 37 female,9 ~ 72 years old, diagnosis(by pathology or by image)was as follwing:24 metastatic encephaloma,48 glioma,19 meningioma,8 pituitary tumor,12 acoustic neurinoma and 4 pinealoma; the sizes of nidus: 10mm to 20mm(n=40), 21mm to 30mm(n=47), 31mm to 40mm(n=25),41mm to 48mm(n=16).The sites of nidus :52 in cerebral hemisphere,15 in saddle area,8 in basal ganglion,6 in clivus,10 in middle cranial fossa base,19 in cerebellum,7 in forth ventricle of cerebrum,11 in cerebellopontine angle.
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The present report summarizes our experience using endoscopes and neuronavigational techniques as an assistance in minimally invasive tool in acoustic neurinoma surgery. Based on the experience in about 100 cases done during the last 5 years using these additional techniques the significant benefit by using both techniques could be proven as absolutely helpful. In our patient collective until now no complications could been detected regarding the use of these options as well as the effectiveness was from very high value. These, for one hand in detecting residual tumor as well as the possibility of controlling the result after the resection using rigid angled endoscopes and for the other hand by the clear efficiency in using neuronavigational systems in planning and performing the approach as well as doing safety drilling by removing the posterior part of the inner auditory channel. Special remarks and recommendations of the technical equipment which has been used are given as well as personal experiences in the operating room set up. Based on our results and experience the use of this two well known techniques in addition to well trained microsurgical techniques can be highly recommended.
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The present report should summarize our experience using minimally invasive techniques in acoustic neurinoma surgery at the Neurosurgical Department,University of Vienna,Austria .Based on the experience of about 687 cases ub a 20year time period our mostly used techniques will be presented. This is a minimal innvasive individual adapted approach,specified intraoperative strategy and dissection tech-niques (e.g.water jet dissection,ultrasonic aspirator CUSA),the use of neuronavigational systems and the use of endoscope assisted surgery.With respect to the Limited space of place precise citations to further textbooks of the authors handling with this topic will be given. Finally our results using these techniques are presented and further future perspectives in the treatment of these pathology(radiosurgery)will be dis-cussed.