Abbas-Kayano Raiene Telassin, Solla Davi Jorge Fontoura, Rabelo Nicollas Nunes, Gomes Marcos de Queiroz Teles, Cabrera Hector Tomas Navarro, Teixeira Manoel Jacobsen, Figueiredo Eberval Gadelha
Neurosurgery Department, University of São Paulo, São Paulo, Brazil.
Acta Otolaryngol. 2020 Mar;140(3):242-245. doi: 10.1080/00016489.2020.1722321. Epub 2020 Feb 12.
Vestibular schwannoma (VS) is a slow-growing, benign tumor that is usually diagnosed when symptoms develop. Surgical management aims to reduce long-term sequelae (LTS) associated with late diagnosis. Identify predictive factors of LTS after VS surgery and clinical outcome measured by modified Rankin scale (mRS). This cohort study included patients submitted to VS surgery from 1999 to 2014, with a mean follow-up of 6.4 ± 4.5 years. Disability was assessed across the mRS the primary outcome was defined by scores 3 to 6, which implied poor outcome in neurological recovery. Predictive factors were identified through multivariate logistic regression. A total of 101 patients were included in this study. Fifty-one (50.49%) presented mRS ≥ 3 on the late postoperative period. Men comprise 22.8%, and the mean age was 47.1 ± 16.0 years (range19-80). Patients with mRS ≥ 3 presented larger tumors (3.7 ± 1.1 cm vs. 3.2 ± 1.0 cm, < .001), less total resection (50% vs. 76.7%, < .010) and more neurofibromatosis II(NFII) (84.9% vs. 64.3%, = .023). On multivariate analysis NFII, tumor size and type resection were predictive of degree of autonomy (mRS ≥3: NF II (OR 3.5, 95% CI 1.08-11.36, = .036) and tumor size (each 1 cm, OR1.51, 95% CI 0.96-2.38, = .050). Tumor size, presence of NFT II, type of surgical approach and number of surgeries were identified as predictive factors of functional sequelae in long-term follow-up after VS surgery.HighlightsOne-third of our patients presented some degree of disability that impact in autonomy (mRS ≥ 3) in the late postoperative period.Tumor size, NFII, surgical approach were predictive to comprise independency.Considering the cranial nerve monitoring and late diagnosis, our results can give some contribution to understanding the Brazilian profile of VS surgery.Our findings suggests the need to look over what it is well recognized and identify aspects that affect the prognosis such as functional disabilities in VS surgery.
前庭神经鞘瘤（VS）是一种生长缓慢的良性肿瘤，通常在出现症状时被诊断出来。手术治疗旨在减少与晚期诊断相关的长期后遗症（LTS）。确定VS手术后LTS的预测因素以及通过改良Rankin量表（mRS）衡量的临床结果。这项队列研究纳入了1999年至2014年接受VS手术的患者，平均随访时间为6.4±4.5年。通过mRS评估残疾情况，主要结局定义为3至6分，这意味着神经功能恢复不良。通过多因素逻辑回归确定预测因素。本研究共纳入101例患者。51例（50.49%）在术后晚期mRS≥3。男性占22.8%，平均年龄为47.1±16.0岁（范围19 - 80岁）。mRS≥3的患者肿瘤更大（3.7±1.1cm对3.2±1.0cm，P<0.001），全切率更低（50%对76.7%，P<0.010），神经纤维瘤病II型（NFII）更多（84.9%对64.3%，P = 0.023）。多因素分析显示，NFII、肿瘤大小和切除类型可预测自主程度（mRS≥3：NF II（比值比3.5，95%置信区间1.08 - 11.36，P = 0.036）和肿瘤大小（每增加1cm，比值比1.51，95%置信区间0.96 - 2.38，P = 0.050）。肿瘤大小、NFII的存在、手术方式和手术次数被确定为VS手术后长期随访中功能后遗症的预测因素。
要点
我们三分之一的患者在术后晚期出现了某种程度的残疾，影响了自主能力（mRS≥3）。
肿瘤大小、NFII、手术方式对自主独立性具有预测作用。
考虑到颅神经监测和晚期诊断，我们的结果有助于了解巴西VS手术的情况。
我们的研究结果表明，需要审视已被充分认识的方面，并识别影响预后的因素，如VS手术中的功能残疾。
