Seol Ho Jun, Kim Choong-hyo, Park Chul-Kee, Kim Chi Heon, Kim Dong Gyu, Chung Young-Seob, Jung Hee-Won
Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, R.O.K.
Neurol Med Chir (Tokyo). 2006 Apr;46(4):176-80; discussion 180-1. doi: 10.2176/nmc.46.176.
Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p=0.620). However, recurrence was significantly less after NTR than STR (p=0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p=0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p=0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.
前庭神经鞘瘤的手术治疗目标是在保留神经功能的前提下实现肿瘤全切。全切可能导致严重功能缺损，而次全切则与高复发率相关。本研究通过回顾1990年至1999年间接受治疗的116例前庭神经鞘瘤患者的临床记录和影像学检查结果，评估了与手术切除范围相关的肿瘤复发风险和术后面神经功能。切除范围分类如下：全切除（GTR）、近全切除（NTR）和次全切除（STR）。面神经功能采用改良House-Brackmann分级，患者分为良好（1-2级）和中等或较差（3-6级）。116例患者中，26例（22%）接受了GTR，32例（28%）接受了NTR，58例（50%）接受了STR。GTR、NTR和STR的复发率分别为3.8%（1/26例）、9.4%（3/32）和27.6%（16/58）。GTR和NTR在复发率方面无统计学显著差异（p=0.620）。然而，NTR后的复发明显少于STR（p=0.043）。GTR术后15.4%的患者面神经功能立即良好，NTR后为40.6%，STR后为46.6%。术后即刻，STR和NTR发生面神经麻痹的风险低于GTR（分别为p=0.006和0.036）。然而，在最后一次随访时，各切除范围组之间在切除范围和术后面神经结果方面未观察到统计学显著差异（p=0.227）。GTR是前庭神经鞘瘤的理想手术治疗方法，但NTR也是一个不错的选择，其面神经功能保留优于GTR，且不会显著增加复发风险。
