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: 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.

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。

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。