Monfared Ashkan, Corrales Carlton E, Theodosopoulos Philip V, Blevins Nikolas H, Oghalai John S, Selesnick Samuel H, Lee Howard, Gurgel Richard K, Hansen Marlan R, Nelson Rick F, Gantz Bruce J, Kutz Joe W, Isaacson Brandon, Roland Peter S, Amdur Richard, Jackler Robert K
*Departments of Otolaryngology and Neurosurgery, George Washington University, Washington, DC; ‡Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Stanford University, Palo Alto, California; §Department of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ¶Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio; ‖Department of Neurosurgery, University of California San Francisco, San Francisco, California; #Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas; **Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York; ‡‡Department of Statistics, California State University, Northridge, Northridge, California; §§Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah; ¶¶Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa; ‖‖Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana; ##Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern, Dallas, Texas.
Neurosurgery. 2016 Aug;79(2):194-203. doi: 10.1227/NEU.0000000000001162.
Patients with large vestibular schwannomas are at high risk of poor facial nerve (cranial nerve VII [CNVII]) function after surgery. Subtotal resection potentially offers better outcome, but may lead to higher tumor regrowth.
To assess long-term CNVII function and tumor regrowth in patients with large vestibular schwannomas.
Prospective multicenter nonrandomized cohort study of patients with vestibular schwannoma ≥2.5 cm who received gross total resection, near total resection, or subtotal resection. Patients received radiation if tumor remnant showed signs of regrowth.
Seventy-three patients had adequate follow-up with mean tumor diameter of 3.33 cm. Twelve received gross total resection, 22 near total resection, and 39 subtotal resection. Fourteen (21%) remnant tumors continued to grow, of which 11 received radiation, 1 had repeat surgery, and 2 no treatment. Four of the postradiation remnants (36%) required surgical salvage. Tumor regrowth was related to non-cystic nature, larger residual tumor, and subtotal resection. Regrowth was 3 times as likely with subtotal resection compared to gross total resection and near total resection. Good CNVII function was achieved in 67% immediately and 81% at 1-year. Better immediate nerve function was associated with smaller preoperative tumor size and percentage of tumor left behind on magnetic resonance image. Degree of resection defined by surgeon and preoperative tumor size showed weak trend toward better late CNVII function.
Likelihood of tumor regrowth was 3 times higher in subtotal resection compared to gross total resection and near total resection groups. Rate of radiation control of growing remnants was suboptimal. Better immediate but not late CNVII outcome was associated with smaller tumors and larger tumor remnants.
CNVII, cranial nerve VIIGTR, gross total resectionHB, House-BrackmannMRI, magnetic resonance imageNTR, near total resectionSTR, subtotal resection.
大型前庭神经鞘瘤患者术后面神经（颅神经VII [CNVII]）功能不良风险较高。次全切除可能带来更好的结果，但可能导致更高的肿瘤复发率。
评估大型前庭神经鞘瘤患者的长期CNVII功能和肿瘤复发情况。
对接受了全切、近全切或次全切除的直径≥2.5 cm的前庭神经鞘瘤患者进行前瞻性多中心非随机队列研究。如果肿瘤残余显示复发迹象，则患者接受放疗。
73例患者获得了充分随访，平均肿瘤直径为3.33 cm。12例接受了全切，22例接受了近全切，39例接受了次全切除。14例（21%）残余肿瘤继续生长，其中11例接受了放疗，1例接受了再次手术，2例未接受治疗。4例放疗后残余肿瘤（36%）需要手术挽救。肿瘤复发与非囊性特征、较大的残余肿瘤和次全切除有关。与全切和近全切相比，次全切除后复发的可能性是其3倍。术后即刻67%的患者获得了良好的CNVII功能，1年后这一比例为81%。更好的即刻神经功能与术前肿瘤较小以及磁共振成像上残留的肿瘤百分比有关。外科医生定义的切除程度和术前肿瘤大小显示出晚期CNVII功能改善的微弱趋势。
与全切和近全切组相比，次全切除后肿瘤复发的可能性高3倍。对生长的残余肿瘤进行放疗的控制率欠佳。更好的即刻而非晚期CNVII结果与较小的肿瘤和较大的肿瘤残余有关。
CNVII，颅神经VII；GTR，全切；HB，House-Brackmann；MRI，磁共振成像；NTR，近全切；STR，次全切除
