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Otolaryngology Volume 52, Issue 9 （September 1980）

耳鼻咽喉科 52巻9号（1980年9月発行）

Japanese English

原著

聴神経腫瘍外科の治療成績—中頭蓋窩経由法および中頭蓋窩経由経迷路・経テント法の成績 RESULTS OF ACOUSTIC NEUROMA SURGERY: Middle Cranial Fossa Approach and Translabyrin Thinetranstentorial Approach via Middle Cranial Fossa 神崎仁 ¹ , 大内利昭 ¹ , 塩原隆造 ² , 戸谷重雄 ² , 斎藤成司 ¹ , 戸谷重雄 ² Jin Kanzaki ¹ ¹慶応義塾大学耳鼻咽喉科学教室 ²慶応義塾大学脳神経外科学教室 pp.623-632

発行日 1980年9月20日 Published Date 1980/9/20

DOI https://doi.org/10.11477/mf.1492209124

PDF(6575KB)

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Abstract 文献概要
1ページ目 Look Inside

　I．はじめに

　聴神経腫瘍（以下ANと略す）に対するHouse^15〜17）らの中頭蓋窩経由法（MCF法と略す）や経迷路法（TL法と略す）の導入により，耳科医のANへの関心が診断面^19,21,25）のみならず治療面^20,23,24）においても高まり，より大きな腫瘍に対しても脳神経外科医とのチームワークにより手術を行うことができるようになったのは，近年この方面における特筆すべき進歩である^{11,29,30,33,40）}。

　とくにTL法およびその拡大法はlateral approachとして小脳・脳幹に対する侵襲が少ないという利点がある反面，脳外科医を満足させるほどの視野が得られないという短所もあった。もちろん，特殊な視野での手術法に対する訓練は必要であるが，チームワークというからには同じ視野で，お互いに得意な面を分担するのが理想的である。

　Results of thirty two cases of acoustic neuroma in the past three and a half years operated on through the middle cranial fossa (mcf) approach, the extended middle cranial fossa and translabyrinthine-transtentorial (TL-TT) approach via mcf by a team of neuro-otologists and neurosurgeons were reported.

　1. Up to present, there was no death, irrespectively of the surgical approaches and of the size of the tumor.

　2. Preservation of hearing was possible in 50% of the cases operated on by the mcf approach.

　3. Total tumor removal was accomplished in 85%, and it was done in all cases by the mcf and its extended method.

　4. The facial nerve was preserved in 75% of the cases operated on by the mcf approach and by its extended method, and in 50% of cases operated on by the TL-TT approach via mcf.

　5. CSF leak and meningitis were the main non-fatal post-operative complications in early cases, but these occurred in less than 10%.

　For larger tumors the TL-TT approach via mcf have the advantage in which both neuro-otologists and neurosurgeons can proceed the operation in the same operative field in contrast with the translabyrinthine approach in which the neurosurgeon finds it difficult to work in the same operative field. Mastoidectomy and labyrinthectomy can be done more easily and in a short time via the mcf than via the mastoid, as in usual labyrinthectomy. By using the mcf approach and its extended approach, tumors of any size could be removed in the one-stage procedure with low postoperative mortality and non-fatal complication rate.