Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois.
Oper Neurosurg (Hagerstown). 2018 Jan 1;14(1):58-65. doi: 10.1093/ons/opx071.
Past studies have shown high rates of ocular complications with the need for ophthalmic surgery following acoustic neuroma resection (ANR).
To determine the rates of ophthalmic complications, referrals, and surgery following ANR, and the factors associated with poor outcomes.
A retrospective study of ophthalmic outcomes in patients who underwent ANR was conducted, following institutional review board approval. Surgical approach, tumor size, tumor characteristics, completeness of resection, postoperative House-Brackmann grades, ocular complications, referrals to ophthalmology, and ophthalmic treatments were recorded.
Between 2007 and 2012, 174 patients underwent ANR. There were 3 surgical groups: retrosigmoid (n = 97), translabyrinthine (n = 59), and combined retrosigmoid and translabyrinthine (n = 18). Median tumor size was 2.2 cm. Postoperatively, 30% of patients had facial nerve dysfunction (House-Brackmann ≥3), which recovered to 19% by 1 mo and 8.6% by 1 yr following ANR. Fifty-six (32.9%) patients experienced ocular complications postoperatively, with lagophthalmos, dry eye, and blurry vision as the most common complications. Thirty-six (67.9%) of the patients who required ophthalmic treatment were managed nonsurgically, with just 13 (7.6%) patients requiring referral to an ophthalmologist. In total, only 9 (5.3%) patients received an ophthalmic procedure. Patients with tumors >2 cm, those undergoing combined retrosigmoid and translabyrinthine resection, and those with severe facial nerve dysfunction which did not improve in the first month following surgery were more likely to have poor ophthalmic outcomes.
We present lower rates of ophthalmic complications following ANR than previously reported. Improved surgical technique, better postoperative eye care, and facial nerve monitoring most likely accounted for the improved ocular outcomes.
过去的研究表明，听神经瘤切除术后（ANR）眼部并发症发生率较高，需要眼科手术。
确定 ANR 后眼部并发症、转诊和手术的发生率，以及与不良预后相关的因素。
在机构审查委员会批准后，对接受 ANR 的患者进行了回顾性眼部结局研究。记录手术入路、肿瘤大小、肿瘤特征、切除程度、术后 House-Brackmann 分级、眼部并发症、转至眼科就诊情况和眼科治疗情况。
2007 年至 2012 年，174 例患者接受了 ANR。有 3 个手术组：乙状窦后（n=97）、迷路后（n=59）和乙状窦后联合迷路后（n=18）。肿瘤中位数大小为 2.2cm。术后 30%的患者出现面神经功能障碍（House-Brackmann 分级≥3），术后 1 个月恢复至 19%，1 年后恢复至 8.6%。56（32.9%）例患者术后出现眼部并发症，最常见的并发症为睑裂闭合不全、干眼症和视力模糊。需要眼科治疗的 36（67.9%）例患者接受了非手术治疗，仅 13（7.6%）例患者需要转诊至眼科医生。总共只有 9（5.3%）例患者接受了眼科手术。肿瘤>2cm、行乙状窦后联合迷路后切除、术后 1 个月面神经功能无改善且严重的患者，更有可能出现不良眼部结局。
我们报告的 ANR 后眼部并发症发生率低于先前报道。手术技术的改进、更好的术后眼部护理和面神经监测可能是眼部结局改善的原因。
