Ferroli Paolo, Bosio Lorenzo, Broggi Morgan
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
Acta Neurochir (Wien). 2017 Jul;159(7):1213-1218. doi: 10.1007/s00701-017-3216-y. Epub 2017 May 22.
Nowadays, there is a general trend in vestibular schwannoma (VS) surgery favoring near-total or subtotal tumor resection (NTR/STR) with facial nerve (FN) function preservation rather than gross total resection (GTR) with high risk of FN damage.
The surgical technique of FN sparing in large VS includes patient-tailored image-guided craniotomy, continuous intraoperative neurophysiological monitoring (INM), intracapsular wide tumor debulking, and only final extracapsular dissection with FN course identification and brainstem decompression. A small amount of residual tumor along the FN is accepted in order to not damage the nerve. Postoperative radiosurgery workup is then recommended.
NTR/STR resection with FN function sparing is a valid option for large VS.
如今，前庭神经鞘瘤（VS）手术的总体趋势是倾向于近全切除或次全切除肿瘤（NTR/STR）并保留面神经（FN）功能，而非进行存在FN损伤高风险的全切除（GTR）。
大型VS保留FN的手术技术包括根据患者定制的影像引导开颅手术、术中连续神经生理监测（INM）、囊内广泛肿瘤减容，以及仅在最后进行囊外解剖以识别FN走行并减压脑干。为避免损伤神经，可接受沿FN的少量残留肿瘤。然后建议进行术后放射外科检查。
保留FN功能的NTR/STR切除是大型VS的一种有效选择。
