Objective To investigate the acoustic neuroma microsurgery techniques and facial/acoustic nerve protection without intraoperative electrophysiological monitoring. Methods Retrospective analysis of 40 imaging - proved acoustic neuromas patients underwent suboccipital - retrosigmoid approach for the tumor resection without intraoperative electrophysiological monitoring was performed. Results Total removal of the tumor was achieved in 38 cases ( 95. 0％ ) ,with subtotal or partial removal in 2 cases ( 5. 0％ ). Facial nerve was anatomically reserved in 28 cases ( 70. 0％ ), with postoperative intact function ( House - Brackmann Ⅰ - Ⅱ grade ) in 8 cases. There was 30. 8％ ( 8/26 ) of facial nerve function preservation rate in cases with normal preoperative function. Acoustic nerve was anatomically reserved in 18 cases ( 45. O％ ), with preserved serviceable hearing in 7 cases. There was 21. 9％ ( 7/32 ) of acoustic nerve function preservation rate in cases with intact preoperative hearing. During follow - up of 27 cases, function reservation of facial nerve and acoustic nerve was observed in 17 ( 63. 0％ ) and 7 ( 25. 9％ ) cases, respectively. Conclusion Familiarity with the anatomy of cerebellopontine region, skillful micro - neurosurgery technique, emphasis of the function protection and post-operative adjuvant therapy are key points of facial / acoustic nerve protection.%目的 探讨听神经瘤的显微外科手术技巧及术中无电生理监测辅助时的面/听神经功能保护.方法 回顾性分析经影像学检查诊断,应用显微神经外科技术,经枕下-乙状窦后入路行肿瘤切除,术中无电生理监测的40例听神经瘤病例,讨论患者面/听神经功能保护.结果 镜下肿瘤全切38例(95.0%),次全切和大部切除2例(5.0%);术中面神经解剖保留28例(70.0%),术后面神经功能保留(House-Brackmann Ⅰ～Ⅱ级)8例,减去手术前已面瘫的14例,早期面神经功能保留率为30.8%(8/26),27例获随访者面神经功能保留17例(63.0%).术中听神经解剖保留18例(45.0%),术后7例存在有效听力,减去手术前已丧失听力的8例,有效听力保留率为21.9%(7/32),获随访者中存在有效听力者7例(25.9%).结论 熟悉桥小脑区的解剖特点,正确的显微神经外科切除方法 和较强的功能保护观念及术后的精心辅助治疗是面/听神经解剖功能保护的重点.
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