「側頭骨外科」聴神経腫ようへの対応―中頭蓋か法を中心に―

DOI
  • 石川 和夫
    秋田大学医学部感覚器学講座耳鼻咽喉科・頭頸部外科
  • Wang Yan
    Department of Sensory Medicine, Division of Otorhinolaryngology, Head and Neck Surgery
  • 本田 耕平
    秋田大学医学部感覚器学講座耳鼻咽喉科・頭頸部外科

書誌事項

タイトル別名
  • Approach for Acoustic Neuroma-focused on middle cranial fossa approach-
  • focused on middle cranial fossa approach
  • 中頭蓋窩法を中心に

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抄録

Surgical approach through middle cranial fossa (MCF) for acoustic neuroma might be a special category among the various types of temporal bone surgery, because the surgical team works with a nerosurgeon. However this approach has significant merit looking down the temporal bone from superior portion and this technique could be applied to control other pathologies of the temporal bone. This approach might have several merits for acoustic neuroma surgery from the viewpoint of functional preservation as has been developed for that purpose by W. House in the middle of last century. Based upon my experience of 57 cases with acoustic neuroma removed by MCF during the past 15 years, the technique and its results were reviewed.<BR>This approach was basically employed for functional preservation, and most of the cases were tried to preserve the function regardless to the degree of the hearing impairments.<BR>To attain this goal, intra-operative monitoring of facial nerve function and hearing by ABR is mandatory. In most of the cases visual observation to identify the facial nerve from the tumor has its limitations, and an operator is obliged to rely upon a facial nerve stimulator.This could provide the best results for facial nerve preservation. However it could become harder when the tumor becomes larger. Regarding our results on the facial nerve, anatomical preservation was attained in 93% of the cases and 86 % were grouped in Class I, II of House-Blackmann's grading system.<BR>On the other hand, measurable hearing preservation rate among cases which has a hearing level belonging to class A & B preoperatively was 64%(14/22). Among these, 8 cases (57%) had more than 50-50 (8/14). Three cases which had a hearing level in Class D preoperatively recovered quite well to Class Bafter the surgery. This may present some evidence to reconsider the validity of the so called 50-50 rule.<BR>Recent development of diagnostic tools, especially MRI, have made it possible to find small tumors which had mild or nearly normal hearing loss. Also, some of the tumors may not grow in size, in other words, doubling time of the tumor should have considerable individual variation. Thus early diagnosis is important, and when it is small, one should confirm its growing tendency before functional reservation surgery is determined, otherwise to wait and scan could be better.

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