Huang Xiang, Xu Ming, Xu Jian, Zhou Liangfu, Zhong Ping, Chen Mingyu, Ji Kaiyuan, Chen Huiyu, Mao Ying
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
World Neurosurg. 2017 Mar;99:326-335. doi: 10.1016/j.wneu.2016.12.055. Epub 2016 Dec 23.
To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.
We selected all patients with large unilateral VS from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30 × 20 mm were defined as large.
A total of 1167 patients with VS were included. Gross total tumor resection was achieved in 1006 patients (86.2%). The mortality rate is 0.77%. The facial nerve was preserved anatomically in 1083 cases (92.8%), and the functional valuation of the facial nerve according to postoperative House-Brackmann scale showed 423 patients (36.2%) in grades I-II, 534 cases (45.8%) in grade III, and 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included new hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) in 634 cases (54.3%), disequilibrium in 250 cases (21.4%), labial herpes in 127 cases (10.9%), meningitis in 115 (9.85%) and lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term complications include hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) (75.8%), permanent facial paralysis (11.9%), facial numbness (10.9%), tinnitus (2.96%), chronic headache (2.25%), and taste disturbance (1.43%).
The key factors for reducing surgical complications include careful assessment of the functions of acoustic and facial nerves as well as a thorough understanding of anatomy via the retrosigmoid approach before operation, skillful microsurgical technique, and monitoring of multiple cranial nerves during resection.
探讨采用枕下乙状窦后入路显微手术治疗大型颅内前庭神经鞘瘤（VS）的常见并发症，并提出将此类并发症降至最低的策略。
我们从收集的数据库（1999 - 2013年）中选取了所有接受显微手术切除作为组织病理学确诊VS初始治疗的大型单侧VS患者。肿瘤大于30×20 mm被定义为大型肿瘤。
共纳入1167例VS患者。1006例（86.2%）实现了肿瘤全切除。死亡率为0.77%。1083例（92.8%）面神经获得解剖学保留，根据术后House - Brackmann量表对面神经进行功能评估显示，Ⅰ - Ⅱ级423例（36.2%），Ⅲ级534例（45.8%），Ⅳ - Ⅵ级210例（18.0%）。术后主要短期并发症包括新发听力损失（美国耳鼻咽喉 - 头颈外科学会D级）634例（54.3%）、平衡失调250例（21.4%）、唇疱疹127例（10.9%）、脑膜炎115例（9.85%）和低位颅神经功能缺损77例（6.59%）。1167例患者中有978例（83.8%）有随访数据。长期并发症包括听力损失（美国耳鼻咽喉 - 头颈外科学会D级）（75.8%）、永久性面瘫（11.9%）、面部麻木（10.9%）、耳鸣（2.96%）、慢性头痛（2.25%）和味觉障碍（1.43%）。
降低手术并发症的关键因素包括术前仔细评估听神经和面神经功能以及通过乙状窦后入路全面了解解剖结构、熟练的显微手术技术以及切除过程中对多条颅神经的监测。
