聴神経腫の外科:50例の自家経験を基にして
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概要
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The acoustic neuroma was discussed in the symptomatological, diagnostic and therapeutic aspects on the basis of own experience in fifty cases. This tumor ranks fourth (12%) among all intracranial tumors of own series.<BR>The accurate analysis of the clinical signs and symptoms is most essential in its diagnosis. Considerable increase of total protein in the cerebro-spinal fluid is present in the majority of the cases. Fractional pneumoencephalography is of the highest value in establishing diagnosis, outlining the structures in the posterior fossa. As treatment, its total removal is ideal, although the radical removal of the intrameatal portion of the tumor is hardly compatible with preserving the facial nerve. The post-operative facial nerve paralysis is one of the most unpleasant complications and should be avoided, if possible. In some cases it may be preferable to maintain the facial nerve rather than sacrificing it completely for radical removal. Mechanical damage to the brain stem during the procedure must be avoided as much as possible. Resection of the lateral 1/3 of the cerebellar hemisphere gives less damage to the brain stem than forcible retraction of the cerebellum throughout the procedure. En-bloc removal is successful only in exceptional cases. Intracapsular curetting to reduce the tumor volume preceding the separation from the cranial nerves and brain stem is thus far more favorable in preserving these important structures. Sitting position is thought to outstand prone posture in obtaining better exposure and reducing blood loss. Operative mortality is 2/33 in sitting position which has been employed since 1959, and none for the last three years. The follow-up study reveals that about 80 % of survival cases are leading useful life, while other 20% have considerable handicaps in daily life such as advanced visual impairment, disturbed equillibrium or occasional headaches.<BR>It should be emphasized that the acoustic neuroma is most benign of the intracranial tumors in every aspect and may be easiest to diagnose, if studied accurately, and should therefore never be overlooked in any case.
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