Thapa Prakash Bahadur, Shahi Sudha, Jha Rajiv Kumar, Shrestha Deependra
Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
Department of Neurosurgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
World J Oncol. 2019 Apr;10(2):118-122. doi: 10.14740/wjon1195. Epub 2019 Apr 20.
Tumors related to the acoustic nerves represent 90% of cerebellopontine angle diseases and have been in the picture for at least 200 years. Famous as acoustic neuromas and vestibular neuromas, these are usually benign, slow-growing tumors of Schwann cells of the myelin sheath. Surgery is the treatment of choice though some authors have suggested "wait and watch" policy. The aims of our study were to study the clinical presentation and management of the tumors, and to evaluate the perioperative outcomes of the surgery.
A retrospective review of the datasheet of 33 patients diagnosed with vestibular schwanomma who had undergone surgery from January 2014 to January 2017 was performed in National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal. Analysis of the demographic data and perioperative outcomes was performed.
Hearing loss was the main presenting symptom in 72% cases followed by tinnitus, dizziness, facial numbness and sudden sensorineural hearing loss. Mean tumur size was 39.7 ± 3 mm. The mean age of the patients was 46 ± 3 years with a female preponderance (1.2:1). In particular, the retrosigmoid route was preferred in all the cases since it was the most employed approach at our center and 63% of the tumors presented to us were grade 5. The surgical techniques allowed safe preservation of the facial function which was 93%. The hearing loss did not improve after the surgery in 94% while it worsened in 6% of cases. We did not find any significant relation between outcome and size, age, gender or laterality of the tumor (P > 0.05). There was no perioperative mortality.
The benign and slow-growing nature of vestibular schwanomma usually poses problems for the early diagnosis and treatment especially in a poor resource setting like ours. Likewise, there are very few studies so far done in the country regarding the incidence and management of the disease. Thus, this study might be helpful in providing insight into the occurrence of the disease in the present scenario and the need for much more studies in the future.
与听神经相关的肿瘤占桥小脑角疾病的90%，至少已有200年的研究历史。这些肿瘤以听神经瘤和前庭神经瘤而闻名，通常是髓鞘施万细胞的良性、生长缓慢的肿瘤。手术是首选治疗方法，不过一些作者建议采用“观察等待”策略。我们研究的目的是研究这些肿瘤的临床表现和治疗方法，并评估手术的围手术期结果。
在尼泊尔加德满都比尔医院的国家医学科学院，对2014年1月至2017年1月期间33例诊断为前庭神经鞘瘤并接受手术的患者的数据表进行回顾性分析。对人口统计学数据和围手术期结果进行分析。
72%的病例中听力损失是主要症状，其次是耳鸣、头晕、面部麻木和突发性感音神经性听力损失。肿瘤平均大小为39.7±3毫米。患者平均年龄为46±3岁，女性占优势（1.2:1）。特别是，所有病例均首选乙状窦后入路，因为这是我们中心最常用的方法，且我们收治的肿瘤中有63%为5级。手术技术能够安全保留93%的面神经功能。94%的患者术后听力损失没有改善，6%的患者听力恶化。我们未发现结果与肿瘤大小、年龄、性别或侧别之间存在任何显著关系（P>0.05）。无围手术期死亡病例。
前庭神经鞘瘤的良性和生长缓慢的特性通常给早期诊断和治疗带来问题，尤其是在像我们这样资源匮乏的环境中。同样，到目前为止，该国关于该疾病发病率和治疗方法的研究很少。因此，本研究可能有助于深入了解当前情况下该疾病的发生情况以及未来开展更多研究的必要性。
