目的 探讨实验性内听动脉阻断与术后听力改变的关系及术中听觉监控的方法。方法 实验兔乙状窦后进路暴露小脑桥脑角，下压小脑暴露内听道及第Ⅷ神经复合体，分辨出内听动脉，予阻断不同时间，分别行蜗神经直接复合动作电位（DcAP）和畸变产物耳声发射记录（DPOAE）。结果 对照组DCAP Nl波潜伏期值无明显改变。内耳血供阻断10s和30s组在压迫开始后3min，DcAP Nl波潜伏期值均恢复为初始值。内耳血供阻断lmin组在压迫开始后3h，DCAP Nl波潜伏期值未恢复为初始值。假手术组I）POAE幅值无明显改变。内耳血供阻断10s、30s对DPOAE幅值无影响，内耳血供阻断1min使得DPOAE幅值下降。结论 兔内耳血供阻断lmin可能造成兔听觉不可逆损伤。DcAP、DPOAE能有效、持续地监控内耳血供阻断，是耳神经外科手术中实用的听觉监测手段。

目的 探讨听神经瘤分期方法及其与手术效果的关系。方法 回顾分析1999-2003年收治的109例听神经瘤病例按肿瘤大小分为1-5期，3例采用观察方法，106例分别采用扩大迷路进路、乙状窦后进路及颅中窝进路等手术治疗，根据肿瘤切除程度、面神经功能保留程度、听力保留程度等评估手术结果。结果 肿瘤全切率为95%（101/106），面神经保留率96%（102/106），迷路进路或扩大迷路进路患者面神经功能优良率（1-2级）为56%，可接受率（1-4）级为86%；听力保存率为42%。结论 听神经瘤的统一分期可以帮助选择治疗方案、评估手术效果，对临床治疗工作有重要指导意义。

Objective: the authors reviewed the clinical manifestations and the surgical outcomes in a series of young patients who underwent removal of large acoustic neuromas via the translabyrinthine approach. Methods: 40 young adults who underwent a translabyrinthine removal of acoustic neuromas 3cm or greater in size were analyzed. The patient's age ranged from 17 to 30 years. The mean size of tumor was 4.25cm. Results: the primary symptoms are similar to those in adult but usually less intense. The average interval time between the primary symptom and the diagnosis was 17 months. A high percentage of preoperative normal hearing (35%) and good facial function (100%) were noted. Translabyrinthine approach was used in all cases. Total removal was realised in 39 patients (97.5%). The facial nerve was anatomically preserved in 37 patients (92.5%). Twenty-six patients (65%) had a good facial function (House-Brackmann grade I or II) immediately or at 1 month after surgery, 11 patients (28%) achieved grade III or IV. Three patients underwent an immediate nerve repair after tumor removal. All of them recovered to grade III or IV 1 year after surgery. Postoperative complications were minimal. Conclusions: young adults may have a rapid growth rate but usually have minimal symptoms even with a large acoustic neuroma. The translabyrinthine approach has been used successfully in removal of large acoustic tumors of young patients, with the good result of facial nerve preservation and long-term tumor control.

Objective: To investigate the surgical techniques and speech performance of multichannel auditory brainstem implant ABI in patients with bilateral acoustic neuromas neurofibromatosis type 2. Methods The nucleus 21 channel auditory brainstem implant was implanted into the lateral recess of the foruth ventricle through the translabyrinthine approach in 7 patients after removal of the tumor. The accurate placement of electrode array was ensured by the electromyogram monitoring of the 7th and 9th nerves and the electrically evoked auditory brainstem responese EABR. Initial switch-on occurred six weeks postoperatively. Speech evaluation was performed every 3 months for the first year and annually thereafter. Results During the surgery the lateral reccess could be found and the typical EABR could in 6 cases. They later reported a significant benefit from the device. Two of the cases have achieved fuctional open-sel speech understanding. In contrast one patient with no EABR because of difficulty of the anatomic location during the surgery had no sensations postoperatively. Conclusion The multichannel ABIcould effectively restore auditory sensations in patients deafened by bilateral acoustic neuromas. The accurate location of the cochlear nucleus complex during surgery was the key factor for the success of the operation.

Objective: To investigate the method, indications and initial results of semiconductor diode laser application in tympanoplasty. Method: The diode laser was used in 14 tympanoplasty procedures. The laser ma-nipulation was mainly used in cases of malleus and incus bony fixation with the tympanum, the fibrous scar tissue around the ossicular chain and the malleus head resection. Result: There was no postoperative vertigo and facial paralysis. The average heraing improvement was 24 dB. Seven cases (50%) reached an air-bone gap within 20 dB. Conclusion: The application of diode laser in tympanoplasty could effectively reduce the manipulation trauma of ossicular chain and control the bleeding of operative field, especially in managing the bony adhesion of the os-sicular chain.

巨大听神经瘤的手术除了要达到安全地全切除肿瘤的目的外外，还要使术后患者面神经功能尽可能保持良好。而即使是一个有经验的耳神经外科医师，在听神经瘤手术中鉴加紧面神经也会有困难，尤其是在巨大听神经瘤手术中。作者自1999年3月至12月在10例巨大听神经瘤切除术中应用面神经监护仪进行面神经监护，取得良好效果，现报道如下。

随着耳显微外科技术的进展，对慢性化脓性中耳炎的手术治疗已不仅仅局限于乳突根治，更多的是在清除病灶的同时重建听力传导结构。但对术式的选择，尤其是开放术式或完壁术式，尚有较大争议。本文分析由同一术者在同一时期完成的开放式鼓室成形术27例、完壁式鼓室成形术18例，比较其适应证、手术方式及疗效，报道如下。

目的：探讨通过扩大的迷路进路切除大听神经瘤的方法和效果。方法：充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜，暴露并下压颈静脉球，内听道周围骨质270以上切除。肿瘤切除从前下极处开始。以早期暴露脑干及脑干表面面神经，随后即从内侧向外侧解剖面神经。结果；18例直径在3cm以上的听神经瘤（平均直径4.2cm）。均手术全切，脑组织无明显损伤。2例术后一过性脑脊液漏自愈。无颅内感染。面神经解剖及功能保存14例，其中8例面神经功能1～2级（44%）。6例面神经功能3～4级（33%）；4例面神经中断者均为术前已有重度面瘫或已中断。16例术后1～3个月恢复工作。2例恢复生活自理。结论：经扩大迷路进路既能全切大听神经瘤。同时又具有损伤小、面神经保存率高等优点。