Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania;
Rom J Morphol Embryol. 2020 Apr-Jun;61(2):485-492. doi: 10.47162/RJME.61.2.18.
We will report our experience of the surgical treatment of large vestibular schwannomas (VSs).
PATIENTS, MATERIALS AND METHODS: We conducted a retrospective study of patients operated on for Koos grade IV VS between 2007 and 2015 at the Department of Neurosurgery, Emergency County Hospital, Târgu Mureş, Romania. We studied the general preoperatory clinical data, the preoperative and postoperative facial nerve status, preoperative hearing on the affected side, and any postoperative complications, including death.
Sixty-six cases were included in our study. The mean age was 52.95 years and 66.7% (n=44) of the sample were female. All patients had suffered from tinnitus and this had been followed by loss of serviceable hearing on the affected side in 89.4% (n=59) of cases. Preoperative facial palsy was found in 53% (n=35) of patients. The mean tumor size was 40.35 mm. Gross-total resection (GTR) was achieved in 24 (36.36%) cases, while near-total resection (NTR) was obtained in 42 (63.64%) cases. New-onset facial palsy or degradation of the preoperative facial deficit occurred in 12 (18.18%) cases, most of whom were patients with a GTR (n=9, 37.5%). This was statistically significant. There were no significant postoperative differences between the GTR and NTR groups. There was one death in the GTR group.
We conclude that near-total tumor removal provides good surgical results and better postsurgical quality of life for patients when compared to gross-total tumor resection. Therefore, this should be the end goal of the resection of large VSs.
我们将报告我们在大型前庭神经鞘瘤（VS）手术治疗方面的经验。
患者、材料和方法：我们对 2007 年至 2015 年在罗马尼亚特兰西瓦尼亚穆雷什紧急县医院神经外科接受 Koos 分级 IV VS 手术的患者进行了回顾性研究。我们研究了一般术前临床数据、术前和术后面神经状态、受影响侧术前听力以及任何术后并发症，包括死亡。
我们的研究包括 66 例病例。平均年龄为 52.95 岁，样本中有 66.7%（n=44）为女性。所有患者均有耳鸣，其中 89.4%（n=59）的患者受影响侧听力丧失。术前发现面神经瘫痪 53%（n=35）的患者。肿瘤平均大小为 40.35mm。实现了全切除（GTR）24 例（36.36%），近全切除（NTR）42 例（63.64%）。新发性面瘫或术前面神经缺陷恶化发生在 12 例（18.18%）患者中，其中大多数为 GTR 患者（n=9，37.5%）。这具有统计学意义。GTR 和 NTR 组之间术后无显著差异。GTR 组有一例死亡。
我们得出结论，与全切除肿瘤相比，近全肿瘤切除为患者提供了良好的手术效果和更好的术后生活质量。因此，这应该是大型 VS 切除的最终目标。
