Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy; Department of Neurosurgery, The State Education Institution of Higher Professional Training, Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy; Department of Neurosurgery, Istituto Nazionale Tumori Regina Elena, Rome, Italy.
World Neurosurg. 2020 Nov;143:e36-e43. doi: 10.1016/j.wneu.2020.04.018. Epub 2020 Apr 16.
To retrospectively analyze clinical and surgical data of a consecutive series of 26 patients with unilateral cystic vestibular schwannomas.
Tumors were classified as type A (central cyst) and type B (peripheral cyst) and as small (tumor diameter <3 cm) and large (tumor diameter >3 cm). All patients underwent microsurgical removal via retrosigmoid approach. The course of the facial nerve (FN) was classified as anterior, anterior-inferior, anterior-superior, and dorsal to the tumor's surface.
Mean patient age was 53.5 years. Mean tumor size was 3.2 cm. There were 22 cases classified as type A and only 4 as type B. Total or near-total resection (>95%) was achieved in 16 cases (61.5%), subtotal removal (90%-95%) was achieved in 9 cases (34.6%), and partial removal (<90%) was achieved in 1 case (3.9%). Position pattern of FN was anterior-inferior in 10 cases (38.4%), anterior-superior in 10 cases (38.4%), anterior in 23.2% of 6 cases. At hospital discharge, FN function was House-Brackmann grade I-V in 9 (36%), 10 (38%), 3 (12%), 3 (12%), and 1 (4%) patients; at final follow-up, House-Brackmann grades I, II, III, and IV accounted for 18 (72%), 6 (24%), 1, and 1 cases. During follow-up ranging from 6 months to 10 years, reoperation for growing of residue was never necessary.
According to the literature and the results of our series, microneurosurgery of cystic vestibular schwannomas is associated with good outcomes in terms of extent of resection and FN function. In particular, long-term FN function is much more satisfactory than short-term function. In most cases, microsurgery represents the treatment of choice of cystic vestibular schwannomas.
回顾性分析 26 例单侧囊性前庭神经鞘瘤连续病例的临床和手术资料。
肿瘤分为 A 型（中央囊肿）和 B 型（周围囊肿），小肿瘤（肿瘤直径<3cm）和大肿瘤（肿瘤直径>3cm）。所有患者均经枕下乙状窦后入路行显微手术切除。面神经（FN）的走行分为肿瘤表面前方、前下方、前上方和后方。
患者平均年龄为 53.5 岁。平均肿瘤大小为 3.2cm。A型 22 例，B 型仅 4 例。16 例（61.5%）实现全切除或近全切除（>95%），9 例（34.6%）实现次全切除（90%-95%），1 例（3.9%）实现部分切除（<90%）。FN 的位置模式为 10 例（38.4%）前下方，10 例（38.4%）前上方，6 例（23.2%）前侧。出院时，FN 功能为 House-Brackmann Ⅰ-Ⅴ级者 9 例（36%），10 例（38%），3 例（12%），3 例（12%），1 例（4%）；末次随访时，House-Brackmann Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为 18 例（72%）、6 例（24%）、1 例、1 例。随访 6 个月至 10 年，无患者因残瘤生长而再次手术。
根据文献和我们的系列研究结果，囊性前庭神经鞘瘤的微创手术在切除程度和 FN 功能方面有良好的效果。特别是，长期的 FN 功能比短期功能更令人满意。在大多数情况下，微创手术是囊性前庭神经鞘瘤的首选治疗方法。
