RESUMEN
Experience in the use of the translabyrinthine approach in removal of neurinomas of the eighth nerve in 14 patients is analysed. It was established that the indications for translabyrinthine removal of this type of new growths should be determined from comparison of the size of the tumor and the size of the operative field with consideration for the inevitable destruction of the hearing apparatus in accomplishing the approach. The translabyrinthine approach was found to be most adequate for small tumors (measuring less than 25 mm in size). The stage-by-stage accomplishment of the translabyrinthine developed by the authors, removal of the tumor, closure of the postoperative wound, and adherence to the suggested methodical instructions ensure atraumatic performance of the operation and prevent operative and postoperative complications. In the presence of strictly determined indications, translabyrinthine removal of neurinomas of the eighth nerve is an operation causing little injury and producing favourable results.
Asunto(s)
Neuroma Acústico/cirugía , Adulto , Oído Interno , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/cirugía , Neuroma Acústico/diagnóstico , Hueso Occipital , Complicaciones Posoperatorias/epidemiologíaRESUMEN
The results of otoneurological and clinical examination were compared with the operative findings in 100 patients with neurinomas of the acoustic nerve. A regularity was found in the frequency of development and the degree of manifestation of some otoneurological and clinical signs depending on the size of the tumor. In 88% of cases the idea of the size of the tumor gained from the results of otoneurological and clinical examination corresponded to the actual size of the new growth determined during the operation.
Asunto(s)
Neuroma Acústico/diagnóstico , Diagnóstico Diferencial , Humanos , Estadificación de Neoplasias , Examen Neurológico , Neuroma Acústico/fisiopatología , Neuroma Acústico/cirugía , Factores de TiempoRESUMEN
Microanatomical study of temporal bone structures and modelling of the translabyrinthine approach (70 specimens) showed that the approach provides extradural access to the internal acoustic meatus and cerebellopontine angle without injury to the nerve structures by stage-by-stage removal of the bony structures of the petrous part of the temporal bone. With this approach the dura mater covering the posterior surface of the internal acoustic meatus can be exposed for its entire length as well as an area of the dura mater of the posterior cranial fossa. The authors revealed considerable variations in the position of temporal bone structures which are the boundaries of the operative field and in the possible microsurgical manipulations in the translabyrinthine approach and removal of the tumor.
Asunto(s)
Ángulo Pontocerebeloso/cirugía , Neuroma Acústico/cirugía , Hueso Petroso/cirugía , Ángulo Pontocerebeloso/anatomía & histología , Humanos , Apófisis Mastoides/cirugía , Métodos , Microcirugia , Hueso Petroso/anatomía & histologíaRESUMEN
Computer-aided tomography (CT) was used in the examination of 259 patients with neurinoma of the acoustic nerve. Characteristic direct and indirect signs of the tumor and the degree of their manifestation depending on the size and predominant direction of the growth of the neurinoma were determined. In 46 patients the size of the tumour established by computer-aided tomography was compared with that revealed on operation. It was established that computer-aided tomography demonstrates exactly the true size of tumors whose compactness is greater than that of the brain matter. It is difficult to determine by CT the true size of tumors of low density and particularly those possessing isodensity; in some cases they are much larger than conceived from analysis of the computer-aided tomograms. Tumors less than 10 mm in diameter which cannot be recognized by ordinary CT can be diagnosed by CT and cisternography with amipak.