Huang X, Ji K Y, Xu J, Shao C H, Wang W, Xu M, Chen D Q, Chen M Y, Zhong P
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Jun 7;51(6):401-7. doi: 10.3760/cma.j.issn.1673-0860.2016.06.001.
To discuss the surgical technique and common complications from the microsurgical treatment of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.
Surgical outcomes and complications were evaluated in a consecutive series of 657 unilateral giant vestibular schwannomas treated in Shanghai Huashan Hospital via suboccipital retrosigmoid approach from 1999 to 2014. According to the international classification of vestibular schwannoma, giant tumor means tumor's size over 4 cm in diameter. Clinical status and complications were assessed postoperatively within 14 days and at follow-ups (range, 6-191 months; mean, 59.6 months).
Follow-up data were available for 566 of the 657 patients (86.1%). The most frequent clinical symptoms were hearing loss in different levels (100%), deafness (36.4%), facial numbness (68.8%). Total tumor resection was achieved in 556 patients (84.6%), subtotal resection in 99 patients (15.1%), and partial resection in 2 patients (0.3%). The common postoperative complications included new deafness (49.6%), intracranial infection (7.6%), low cranial nerve defect (7.5%) and pneumonia (6.2%). The facial nerve was preserved anatomically in 589 cases (89.6%) after operation, and the functional valuation of facial nerve according to postoperative House-Brackmann showed 216 patients (32.9%) in grade Ⅰ-Ⅱ, 308 cases (46.9%) in grade Ⅲ, 133 patients (20.2%) in grade Ⅳ-Ⅵ. Long-term followed-up results showed 428 patients (75.6%) in grade Ⅰ-Ⅲ one year after surgical treatment.
Many of these complications are avoidable. Surgical experiences and the clinical anatomy of the approach, accompany with using intraoperative nerve monitoring, preoperatively study the individual imaging and clinical data and multidisciplinary cooperation are the key points to avoid the complications of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach.
探讨经枕下乙状窦后入路显微手术治疗巨大颅内前庭神经鞘瘤的手术技巧及常见并发症，并提出减少此类并发症的策略。
对1999年至2014年在上海华山医院经枕下乙状窦后入路治疗的657例单侧巨大前庭神经鞘瘤患者的手术结果及并发症进行评估。根据前庭神经鞘瘤的国际分类，巨大肿瘤是指直径超过4 cm的肿瘤。术后14天内及随访（范围6 - 191个月；平均59.6个月）时评估临床状况及并发症。
657例患者中有566例（86.1%）有随访数据。最常见的临床症状为不同程度的听力损失（100%）、耳聋（36.4%）、面部麻木（68.8%）。556例患者（84.6%）实现肿瘤全切，99例患者（15.1%）次全切切除，2例患者（0.3%）部分切除。常见术后并发症包括新发耳聋（49.6%）、颅内感染（7.6%）、低位脑神经缺损（7.5%）及肺炎（6.2%）。术后589例（89.6%）面神经解剖保留，根据术后House - Brackmann对面神经功能评估显示，Ⅰ - Ⅱ级216例（32.9%），Ⅲ级308例（46.9%），Ⅳ - Ⅵ级133例（20.2%）。长期随访结果显示，手术治疗1年后428例患者（75.6%）为Ⅰ - Ⅲ级。
这些并发症大多是可以避免的。手术经验及该入路的临床解剖知识，术中使用神经监测，术前研究个体影像学及临床资料以及多学科合作是经枕下乙状窦后入路避免巨大颅内前庭神经鞘瘤并发症的关键要点。
