Rahimpour Shervin, Friedman Allan H, Fukushima Takanori, Zomorodi Ali R
Department of Neurosurgery, Duke University Medical Center, 1000 Trent Drive 4520 Hosp South, Box 3807, Durham, NC, 27710, USA.
Carolina Neuroscience Institute, 4030 Wake Forest Rd suite 115, Raleigh, NC, 27612, USA.
J Neurooncol. 2016 Nov;130(2):367-375. doi: 10.1007/s11060-016-2260-4. Epub 2016 Sep 20.
Vestibular schwannoma (VS) surgery requires appropriate patient selection, meticulous microsurgical technique and optimal post-operative care. Focused radiation is an effective alternative for the treatment of smaller VSs. For VS surgery to remain a reasonable option, surgery must be performed with a limited number of complications. Complication rates for VS surgery have increased over the last decade. This is likely due to (1) decreased surgical volume and as a result decreased microsurgical experience, (2) larger tumors undergoing surgery while smaller tumors are reserved for radiation, and (3) surgery for previously radiated tumors resulting in more difficult anatomic dissection. Appropriate management of complications is paramount. Herein, we discuss complications related to VS microsurgery and methods of avoidance. Specifically, we discuss the most frequently encountered complications, intraoperative monitoring and finally, methods of addressing these complications. With meticulous microsurgical technique, careful intraoperative monitoring and vigilant perioperative care one will ensure optimal patient outcomes.
前庭神经鞘瘤（VS）手术需要恰当的患者选择、精细的显微外科技术及最佳的术后护理。聚焦放疗是治疗较小VS的有效替代方法。为使VS手术仍成为合理选择，手术必须在并发症数量有限的情况下进行。在过去十年中，VS手术的并发症发生率有所上升。这可能是由于：（1）手术量减少，从而显微外科经验减少；（2）手术的肿瘤体积增大，而较小的肿瘤留作放疗；（3）对先前接受过放疗的肿瘤进行手术，导致解剖分离更加困难。恰当处理并发症至关重要。在此，我们讨论与VS显微手术相关的并发症及避免方法。具体而言，我们讨论最常遇到的并发症、术中监测，最后是处理这些并发症的方法。通过精细的显微外科技术、仔细的术中监测及警惕的围手术期护理，将确保患者获得最佳预后。
