Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Laryngoscope. 2021 Apr;131(4):E1328-E1334. doi: 10.1002/lary.29141. Epub 2020 Oct 2.
To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection.
Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system.
One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm (range: 0.01-30.6 cm ), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection.
Tumor volume >3 cm is associated with worse facial nerve outcomes 12 months following surgical resection.
IV Laryngoscope, 131:E1328-E1334, 2021.
探讨听神经鞘瘤（VS）切除后面神经结局与肿瘤大小的关系。
对 2008 年至 2018 年间接受未经治疗的散发性 VS 手术切除的所有成年患者进行单机构回顾性图表回顾，这些患者均有术前磁共振成像（MRI）和 1 年随访。主要结局评估指标是采用 House-Brackmann 面神经分级系统评估的面神经结局。
共确定了 167 名患者，女性占 54.5%，中位年龄为 49 岁（20-76 岁），他们接受了 VS 切除术。手术切除采用经迷路（76.7%）、中颅窝（14.4%）、乙状窦后（7.2%）和经岩骨（1.8%）入路。肿瘤直径和体积的中位数分别为 25.3mm（范围：4.1-47.1mm）和 3.17cm（范围：0.01-30.6cm）。中位随访时间为 24.2 个月（范围：12-114.2 个月）。79%的病例行全切除，17%的病例 MRI 显示有残留肿瘤。对于肿瘤<3cm 的患者，至少 1 年随访后 92.7%的患者面神经功能为 1 级或 2 级，而肿瘤>3cm 的患者为 81.2%（单变量逻辑回归 OR=2.9，P=.03）。多变量回归分析显示，肿瘤体积>3cm 是面神经无力的预测因素（OR=7.4，P=.02），控制手术入路、内听道延伸、前伸、年龄、性别和切除程度。
肿瘤体积>3cm 与术后 12 个月面神经结局较差相关。
IV 级 Laryngoscope, 131:E1328-E1334, 2021.
