摘要
目的探讨听神经瘤出现视力改变的原因以及出现眼部症状的听神经瘤的临床特点、诊疗方法及其疗效.方法回顾性分析2014年1月至2023年4月收治的有眼部症状的16例听神经瘤的临床资料.结果 16中,年龄<40岁有9例,大型或巨大型肿瘤占81.25%,术前均合并有脑积水.16例均采取乙状窦后入路手术切除肿瘤;术前行脑室穿刺外引流术5例,行Omaya囊置入术3例,术中行侧脑室-枕大池分流术1例,术后脑积水加重行脑室穿刺外引流术2例,术后脑积水未缓解行脑室-腹腔分流术2例.肿瘤全切除13例;次全切除3例,术后行伽玛刀治疗.16例面神经均解剖保留,术后2周复查显示视力好转8例,无改善3例,恶化5例(3例双目失明,2例光感).术后随访6个月,13例肿瘤全切除者无复发、3例次全切除者无进展;8例视力好转者恢复正常,3例视力无改善者有好转,5例视力恶化者无改善(3例双目失明,2例光感).结论中青年大型听神经瘤合并脑积水易发生视力改变,容易误诊.确诊后,应尽早手术缓解脑积水,挽救视力,术后脑积水缓解率高.术前视神经萎缩者,术后视力恢复差.
Abstract
Objective To explore the causes of visual changes in patients with acoustic neuromas presenting with ocular symptoms and the clinical characteristics,diagnostic and therapeutic methods of these patients.Methods The clinical data of 16 patients with acoustic neuroma presenting with ocular symptoms admitted from January 2014 to April 2023 were retrospectively analyzed.Results All 16 patients had preoperative hydrocephalus.Nine patients were under 40 years old.Large or giant tumors accounted for 81.25%.All 16 patients underwent tumor resection via the retrosigmoid approach.Preoperatively,5 cases underwent ventricular puncture and external drainage,3 cases underwent Omaya cyst implantation,and 1 case underwent lateral ventricle-cisterna magna shunt during the operation.Postoperatively,2 cases with aggravated hydrocephalus underwent ventricular puncture and external drainage,and 2 cases with unrelieved hydrocephalus underwent ventriculoperitoneal shunt.Total tumor resection was achieved in 13 cases,and subtotal resection in 3 who were followed by gamma knife therapy.The facial nerve was anatomically preserved in all 16 cases.The reexamination 2 weeks after the operation revealed that vision improved in 8 cases,remained unchanged in 3 cases,and deteriorated in 5 cases(3 blind in both eyes,2 light perception).During the 6-month postoperative follow-up,none of the 13 cases with total tumor resection had recurrence,and the 3 cases with subtotal resection showed no progression.The vision returned to normal in the 8 cases with improved vision 2 weeks after the operation.The vision improved in the 3 cases with unchanged vision 2 weeks after the operation.There was no improvement in the 5 cases with deteriorated vision 2 weeks after the operation.Conclusions Young and middle-aged patients with large acoustic neuromas associated with hydrocephalus are prone to visual changes and are easily misdiagnosed.After diagnosis,hydrocephalus should be relieved by surgery as soon as possible to salvage vision,and the remission rate of hydrocephalus after the operation is high.For patients with preoperative optic nerve atrophy,the recovery of vision after the operation is poor.
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