Peng Kevin A, Chen Brian S, Lorenz Mark B, Lekovic Gregory P, Schwartz Marc S, Slattery William H, Wilkinson Eric P
House Clinic, Los Angeles, California, United States.
Ear Nose and Throat Surgery Clinic, William Beaumont Army Medical Center, El Paso, Texas, United States.
J Neurol Surg B Skull Base. 2018 Dec;79(6):528-532. doi: 10.1055/s-0038-1635256. Epub 2018 Apr 9.
To describe clinical outcomes of patients undergoing revision surgery for vestibular schwannomas. Retrospective case series. Tertiary private neurotologic practice. Patients who underwent revision surgeries for recurrent/residual vestibular schwannomas between 1985 and 2015. Degree of resection, facial nerve function, cerebrospinal fluid (CSF) leak. A total of 234 patients underwent 250 revision surgeries for recurrent/residual vestibular schwannomas. Of these, 86 carried a diagnosis of neurofibromatosis type 2 (NF2). The mean number of prior surgeries was 1.26, and 197 (85%) prior surgeries had been performed elsewhere. The average age at surgery was 43. The most common approach employed at the time of revision surgery was translabyrinthine (87%), followed by transcochlear (6%), middle fossa (5%), and retrosigmoid (2%). Gross total resection was achieved in 212 revision surgeries (85%). Preoperative House-Brackmann facial nerve function was similar in non-NF2 and NF2 groups (mean: 2.7). Mean postoperative facial nerve function at last follow-up was 3.8 in the non-NF2 group and 3.9 in the NF2 group. History of radiation and the extent of resection were not associated with differences in facial nerve function preoperatively or postoperatively. CSF leaks occurred after 21 surgeries (8%), and six (2%) patients required reoperation. This is the largest series of revision surgery for vestibular schwannomas to date. Our preferred approach is the translabyrinthine craniotomy, which can be readily modified to include the transcochlear approach for improved access. CSF leak rate slightly exceeds that of primary surgery, and gross total resection is achievable in the vast majority of patients.
描述接受前庭神经鞘瘤翻修手术患者的临床结局。 回顾性病例系列研究。 三级私立神经耳科诊所。 1985年至2015年间接受复发性/残留性前庭神经鞘瘤翻修手术的患者。 切除程度、面神经功能、脑脊液（CSF）漏。 共有234例患者接受了250次复发性/残留性前庭神经鞘瘤的翻修手术。其中，86例诊断为2型神经纤维瘤病（NF2）。既往手术的平均次数为1.26次，197例（85%）既往手术在其他地方进行。手术时的平均年龄为43岁。翻修手术时最常用的入路是经迷路入路（87%），其次是经耳蜗入路（6%）、中颅窝入路（5%）和乙状窦后入路（2%）。212例翻修手术（85%）实现了肿瘤全切除。非NF2组和NF2组术前House-Brackmann面神经功能相似（平均：2.7）。非NF2组末次随访时的平均术后面神经功能为3.8，NF2组为3.9。放疗史和切除范围与术前或术后面神经功能差异无关。21例手术（8%）后发生脑脊液漏，6例（2%）患者需要再次手术。 这是迄今为止最大的前庭神经鞘瘤翻修手术系列研究。我们首选的入路是经迷路开颅术，可根据需要灵活改为经耳蜗入路以改善显露。脑脊液漏发生率略高于初次手术，绝大多数患者可实现肿瘤全切除。
