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Micro-surgery with Gamma Knife radiosurgery of large acoustic neuromas

Stereotactic neurosurgery with the development of technology for the treatment of large acoustic neuromas we use as retention, patient face, the auditory nerve function, the tumor resection, rather residue and adhesion of the facial nerve near and around the tumor. Separation of neural anatomy and not forced. Residual tumors stereotactic radiosurgery, and achieved satisfactory results, the majority of patients willing to accept. 3.1 pairs of large acoustic neuroma surgery treatment: high-quality completion of large tumors (40mm),[link widoczny dla zalogowanych], is still the neurosurgeon faced serious challenges. The performer anatomical knowledge and a wealth of local skilled surgical technique is the basis for the success of surgery. Total removal of large acoustic neuroma is a considerable risk, despite the full preparation before surgery. But the surgery is still difficult to avoid damage the nervous system (brain stem, cranial nerves and blood vessels) and post-operative complications (cerebrospinal fluid leakage, hematoma, infection, etc.) occur. Large acoustic neuroma facial nerve in patients with prolonged pressure. Often elongated, thin and with the adhesion of arachnoid or brain stem, sometimes wrapped in the tumors, the rule of thumb is difficult to identify and separate the facial nerve. Therefore, post-operative facial nerve dysfunction has occurred is difficult to estimate. We use a small incision behind the ear pillow anti-arc descendants Road sigmoid sinus, most consciously or part of tumor resection, as little as possible or not to dissecting the facial nerve. Often in the face of God in front of the tumor, or before the bottom before the top, so the back side cut from the tumor, removal of most of the tumor is very safe. If carried out in the surgery of facial nerve function monitoring, will be more conducive to the protection of a facial nerve. Surface in the effective protection of the auditory nerve, while the remains of the tumor as possible is less than 30mm or less. With cystic change of tumor cystic fluid aspiration, after widening the crevasse, and the separation, do not force to peel wall, because the facial nerve is often a more closely with the wall adhesions. After wound suture removal as well that can be arranged to restore the body gamma knife treatment; recovery can be two weeks or one month less after gamma knife treatment. The group of 10 patients were followed up six to 12 months to achieve better therapeutic effect. 3.2 The principles of radiosurgery: use of acoustic neuroma radiosurgery increasing number of patients. U.S. diagnosed each year about 2,500 cases of acoustic neuroma patients who received radiosurgery for about 2o, increasing year by year. It is estimated that 2020 patients received radiosurgery for up to 8O,[link widoczny dla zalogowanych], then only the oppression of the brain stem or larger tumors (diameter greater than 30mm) required surgical removal of facilities (about 2O). Stereotactic radiosurgery include: Gamma Knife (GAMMAKNIFE),[link widoczny dla zalogowanych], linear accelerator, with its treatment of the effects of acoustic neuroma has been recognized. Surgical treatment of patients worldwide have received radiation more than 8000 cases, proof of acoustic neuroma radiosurgery is safe and reliable. Flickinger and so on. Gamma Knife was the use of 19O cases of acoustic neuroma patients treated, marginal dose 13Gy. Center for the maximum dose 26Gy, 5-year tumor control results for the rate of 97, facial paralysis 1.1. Gamma Knife treatment generally applied to patients with grade I ~ Ⅱ. Tumor size is limited 3Omm the following special circumstances, diameter 39mm. Center dose of 22 - 36Gy, the average dose of 26Gy. Peripheral dose 1l ~ 18Gy. The advantage is no operative mortality, morbidity is low; tumor control rate, hearing,[link widoczny dla zalogowanych], facial nerve function preservation rate; trauma. No intracranial bleeding, infection and cerebrospinal fluid leak complications. So for less than 30mm of the tumor; recurrence; residues persons and bilateral acoustic neuroma or general poor condition can not tolerate surgery, or do not want surgery as the preferred method. To the side effects, including increased cancer who needed surgery to be ahead of hydrocephalus shunt surgery. Bring any other radioactive side effects long term remains to be seen.
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