右江医学2026，Vol.54Issue(2)：105-112,8.DOI:10.3969/j.issn.1003-1383.2026.02.001
听神经瘤治疗中神经功能保护的策略演进与多模态整合
Evolution of strategies for neurofunctional protection and multimodal integration in the treatment of acoustic neuromas
摘要
Abstract
Vestibular schwannoma(VS),as the most common benign tumor in the cerebellopontine angle region,necessitates paramount importance on nerve function preservation during treatment.This review summarizes advancements in strategies for avoiding nerve injury.In imaging,the Koos grading system guides therapeutic decision-making;diffusion tensor imaging(DTI)enables visual localization of the facial nerve;fundal fluid cap(FFC)sign predicts hearing preservation;multifactorial nomograms allow precise prediction of postoperative facial nerve function;and immediate postoperative MRI(first-day)helps differentiate between tumor residue and scar tissue.Surgical optimizations include:subperineural/bidirectional dissection techniques to reduce injury to the intermediate nerve;the semi-sitting position improves facial nerve outcomes and reduces venous air embolism;endoscopic assistance facilitates total resection of intracanalicular tumors and hearing preservation;sodium fluorescein enhances intraoperative tumor boundary delineation;augmented reality(AR)aids surgical navigation;and intraoperative electrophysiological monitoring(e.g.CNAP)increases nerve preservation rates.Advances in radiotherapy reveal:stereotactic radiosurgery(SRS)achieves a 10-year control rate of 86.7%for Koos grade Ⅳ AN;lower marginal dose and cochlear dose constraints aid hearing preservation;subtotal resection(STR)combined with delayed SRS balances tumor control and neurological function.Machine learning optimizes preoperative assessment.Future efforts should focus on integrating multimodal data to achieve the goal of"zero injury"to neurological functions.关键词
听神经瘤/面神经保护/听力保留/显微手术/立体定向放射外科/术中监测/机器学习Key words
vestibular schwannoma(VS)/facial nerve preservation/hearing preservation/microsurgery/stereotactic radiosurgery(SRS)/intraoperative monitoring/machine learning分类
医药卫生引用本文复制引用
武天阳,潘仲涔,姜之全..听神经瘤治疗中神经功能保护的策略演进与多模态整合[J].右江医学,2026,54(2):105-112,8.基金项目
安徽省卫生健康委科研项目(AHWJ2023A10099) （AHWJ2023A10099）
