Bartek Jiri, Förander Petter, Thurin Erik, Wangerid Theresa, Henriksson Roger, Hesselager Göran, Jakola Asgeir Store
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Front Neurol. 2019 Jan 29;10:43. doi: 10.3389/fneur.2019.00043. eCollection 2019.
Vestibular Schwannoma (VS) is a benign neoplasm arising from the 8th cranial nerve, with surgery one of the treatment modalities. In a nation-wide registry study, we describe the baseline, treatment characteristics, and short-term outcome in patients surgically treated for VS. We performed a nationwide study with data from the Swedish Brain Tumor Registry (SBTR) for all adults diagnosed with VS 2009-2015. Patient symptoms, tumor characteristics, and postoperative complications were analyzed. In total 348 patients underwent surgery for VS. Mean age was 50.6 ± 14.5 years and 165 patients (47.4%) were female. The most common symptom was focal neurological deficit (92.0%), with only 25 (7.2%) being asymptomatic prior to surgery, and 217 (63.6%) had no restriction in activity. Following surgery, 100 (28.7%) patients developed new deficit(s). In terms of postoperative complications; 11 (3.2%) had a hematoma, 35 (10.1%) an infection, 10 (2.9%) a venous thromboembolism, and 23 (6.6%) had a reoperation due to complication. There were no deaths within 30-days after surgery. When grouped according to tumor size (< 4 vs. ≥4 cm), those with ≥4 cm tumors were more often males ( = 0.02), had more often ICP related symptoms ( = 0.03) and shorter time from imaging to surgery ( < 0.01). Analysis of the younger (< 65 years) vs. elderly (≥65 years) revealed no difference in outcome except increased 1-year mortality ( = 0.002) in elderly. In this nation-wide registry-study, we benchmark the 30-day complication rate after VS surgery as collected by the SBTR. Further, we present the current neurosurgical outcome data from both VS smaller than 40 mm compared to larger tumors, as well as younger vs. elderly VS patients. Since surgical decision making is a careful consideration of short term risk vs. long term benefit, this information can be useful in clinical decision making.
前庭神经鞘瘤（VS）是一种起源于第8颅神经的良性肿瘤，手术是其治疗方式之一。在一项全国性登记研究中，我们描述了接受VS手术治疗患者的基线情况、治疗特征和短期预后。我们利用瑞典脑肿瘤登记处（SBTR）的数据，对2009年至2015年期间所有诊断为VS的成年患者进行了一项全国性研究。分析了患者症状、肿瘤特征和术后并发症。共有348例患者接受了VS手术。平均年龄为50.6±14.5岁，165例患者（47.4%）为女性。最常见的症状是局灶性神经功能缺损（92.0%），术前仅25例（7.2%）无症状，217例（63.6%）活动无受限。术后，100例（28.7%）患者出现了新的神经功能缺损。在术后并发症方面，11例（3.2%）出现血肿，35例（10.1%）发生感染，10例（2.9%）出现静脉血栓栓塞，23例（6.6%）因并发症接受了再次手术。术后30天内无死亡病例。根据肿瘤大小分组（<4 cm与≥4 cm），肿瘤≥4 cm的患者男性更常见（P = 0.02），更常出现与颅内压相关的症状（P = 0.03），从影像学检查到手术的时间更短（P<0.01）。对年轻（<65岁）与老年（≥65岁）患者的分析显示，除老年患者1年死亡率增加（P = 0.002）外，预后无差异。在这项全国性登记研究中，我们对SBTR收集的VS手术后30天并发症发生率进行了基准分析。此外，我们展示了与较大肿瘤相比，直径小于40 mm的VS以及年轻与老年VS患者目前的神经外科手术预后数据。由于手术决策需要仔细权衡短期风险与长期获益，这些信息对临床决策可能有用。
