听神经瘤的治疗抉择 ——实现肿瘤切除与神经功能保护的完美统一

Management of acoustic neuroma——Complete removal of tumor with neural function preservation

摘要:

听神经瘤治疗方法包括显微手术、放射治疗、保守观察。随着听神经瘤生长规律研究的进展与显微手术技术的不断进步，治疗方式的选择争议不断。回顾近年来听神经瘤治疗的文献并结合研究结果，以神经功能保留和患者远期生活质量作为评价和选择治疗方法的依据，认为出现症状的听神经瘤患者，应首选手术治疗；乙状窦后入路适应于大、中、小各型听神经瘤，肿瘤全切除率高，死残率和并发症发生率低，能很好的保留面神经功能和听力，是治疗听神经瘤的较好选择。放射治疗是部分听神经瘤患者可选择的替代治疗方法。听神经瘤的保守观察需审慎。

关键词:听神经瘤|显微外科|放射治疗|保守观察

Abstract:

Contemporary treatment strategy of acoustic neuroma includes microsurgical resection, radiotherapy, and conservative observation (watchful waiting). Along with the advances in research on the growing patterns of this tumor and improvement of microsurgical techniques, there has been controversy about treatment options. According to our study and relevant literatures about ways of treatment for acoustic neuroma in recent years, it is concluded that microsurgical treatment is the optimal choice for the patients with symptoms taking the neural function preservation and the longterm life quality of patients as the bases for selection. With advantages of comprehensive indications (applicable to tumors of all sizes), high total resection rate, low rates of mortality, disability and complications, and proper neural function preservation and hearing conservation, the retrosigmoid approach is a preferable approach for surgical removal of acoustic neuroma. Radiotherapy is a good replacement therapy for the patients with surgical contraindications. Conservative observation (watchful waiting) should be applied prudently.

Key words:Acoustic neuroma| Microsurgery|Radiotherapy| Observation