Labib Mohamed A, Inoue Mizuho, Banakis Hartl Renee M, Cass Stephen, Gubbels Samuel, Lawton Michael T, Youssef A Samy
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
Department of Neurosurgery, University of Colorado, CO, Aurora, USA.
Acta Neurochir (Wien). 2021 Aug;163(8):2219-2224. doi: 10.1007/s00701-020-04678-y. Epub 2021 Jan 3.
Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.
The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.
Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House-Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.
Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.
小型前庭神经鞘瘤（VSs）的治疗仍存在争议。当选择手术治疗时，保留面神经和听神经功能是首要任务。在本报告中，我们介绍并评估一种在解剖学上保留前庭神经的技术，以尽量减少操作并保留面神经和听神经的功能。
前瞻性地应用前庭神经保留技术切除术前听力尚可（美国耳鼻咽喉头颈外科学会（AAO-HNS）A级或B级）的小型VS肿瘤患者。记录并分析临床和影像学数据。
10例患者符合纳入标准。平均（标准差）年龄为40.4（12.5）岁。随访时间为6周至2年。与内耳道平行的肿瘤最大直径为10至20毫米（平均，14.9（3.1）毫米）。有3例Koos 3级和7例Koos 2级肿瘤。所有病例均实现了肿瘤全切。所有病例均在解剖学上保留了面神经和听神经。术后，7例患者（70%）仍处于AAO-HNS A级或B级听力类别。所有患者均无新的前庭症状，且面神经功能均为House-Brackmann 1级。术前1例患者观察到中间神经功能障碍，术后加重。2例患者术后出现新的中间神经症状。
在小型VS切除术中通过有意保留前庭神经来改善面神经和听力结果是可行的。需要更长时间的随访以排除肿瘤复发。
