Zhu Zheng Jie, Zhu Wei Dong, Chen Hong Sai, Wang Zhao Yan, Wu Hao
Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
Eur Arch Otorhinolaryngol. 2016 May;273(5):1115-21. doi: 10.1007/s00405-015-3639-0. Epub 2015 May 22.
The aim of the study was to describe the refinements to the classic enlarged translabyrinthine approach (ETLA) by modifying the bony dissection range of temporal bone and to analyze the main outcomes achieved in a series of vestibular schwannoma (VS) cases submitted to microsurgery by ETLA. This was a retrospective study of 382 patients who underwent VS surgical removal via ETLA between January 2001 and December 2012. Among those cases, 332 were via classic ETLA, while 28 cases were via ETLA with blind sac technique and middle ear eradication and 22 via transotic approach. Total tumor removal was achieved in 368 cases, whereas near total removal in 11 patients and subtotal in 3 patients. In cases of large VS (>3 cm) via classic ETLA, good short-term and long-term facial nerve function (HB I-II) was gained in 27.8 % (32/115) and 42.6 % (49/115) cases, respectively, meanwhile in VS operated via blind sac technique, good short-term (p = 0.048) and long-term (p = 0.044) facial nerve function was reached in 44.0 % (22/50) and 60.0 % (30/50) cases, respectively. Postoperative facial nerve function was proved to be better in modified ETLA group. CSF leakage occurred in 16 (4.2 %) patients via classic ETLA. In 115 cases of large VS (>3 cm), postoperative CSF leakage occurred in 10 (8.7 %) patients. Whereas in 50 cases via blind sac technique, none developed CSF leakage (p = 0.03). The incidence of CSF leakage was lower in modified ETLA group. Our refinements to classic ETLA by changing the temporal bone resection range provide a wide surgical field, well prevention of CSF leakage and preservation of facial nerve function in large VS.
本研究的目的是通过修改颞骨的骨质切除范围来描述对经典扩大经迷路入路（ETLA）的改进，并分析一系列接受ETLA显微手术的前庭神经鞘瘤（VS）病例所取得的主要结果。这是一项对2001年1月至2012年12月间通过ETLA接受VS手术切除的382例患者的回顾性研究。在这些病例中，332例采用经典ETLA，28例采用带盲袋技术和中耳根除的ETLA，22例采用经外耳道入路。368例实现了肿瘤全切除，11例为近全切除，3例为次全切除。在经典ETLA治疗的大型VS（>3 cm）病例中，分别有27.8%（32/115）和42.6%（49/115）的病例获得了良好的短期和长期面神经功能（HB I-II级），同时在采用盲袋技术手术的VS病例中，分别有44.0%（22/50）和60.0%（30/50）的病例获得了良好的短期（p = 0.048）和长期（p = 0.044）面神经功能。改良ETLA组的术后面神经功能更好。经典ETLA组有16例（4.2%）患者发生脑脊液漏。在115例大型VS（>3 cm）病例中，10例（8.7%）患者术后发生脑脊液漏。而在采用盲袋技术的50例病例中，无一例发生脑脊液漏（p = 0.03）。改良ETLA组的脑脊液漏发生率较低。我们通过改变颞骨切除范围对经典ETLA的改进为大型VS提供了广阔的手术视野、良好的脑脊液漏预防和面神经功能保留。
