Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China.
Clin Neurol Neurosurg. 2021 Aug;207:106768. doi: 10.1016/j.clineuro.2021.106768. Epub 2021 Jun 22.
The semisitting position (SSP) and lateral position (LP) in vestibular schwannoma (VS) surgery each have advantages and disadvantages, and which position is superior overall is debatable. Our objective was to determine the optimal position for surgical treatment of VSs with a diameter ≥3 cm.
We retrospectively evaluated consecutive patients with a large VS treated between January 2010 and July 2020. Patients were grouped by surgical position and analyzed.
We enrolled 259 patients (LP group, n = 156; SSP group, n = 103). The resection extent was not significantly different between the SSP (gross-total resection [GTR], n = 89 [88.1%], near-total resection [NTR], n = 10 [9.9%], subtotal resection [STR], n = 2 [2.0%]) and LP (GTR, n = 125 [80.1%]; NTR, n = 24 [15.4%]; STR, n = 7 [4.5%]) groups. The rate of GTR with facial nerve (FN) functional preservation was higher in the SSP group than in the LP group (P = 0.014) at eight days after the operation. However, during follow-up (SSP group median, 31.5 months; LP group median, 19.5 months), there was no significant between-group difference in FN functional preservation. Two patients in the SSP group required conversion to the LP due to severe intraoperative venous air embolism (VAE).
Compared with the LP, the SSP did not produce significantly better FN outcomes in patients with a large VS. The duration of surgery was significantly longer in SSP cases than in LP cases. Given the risk of VAE associated with the SSP, the selection of the optimal surgical position should be made with caution on an individual basis.
半坐位（SSP）和侧卧位（LP）在听神经鞘瘤（VS）手术中各有优缺点，哪种体位总体上更优存在争议。我们的目的是确定直径≥3cm 的 VS 手术的最佳体位。
我们回顾性评估了 2010 年 1 月至 2020 年 7 月期间连续接受大型 VS 治疗的患者。根据手术体位将患者分组并进行分析。
我们纳入了 259 名患者（LP 组，n=156；SSP 组，n=103）。SSP 组（全切[GTR]，n=89[88.1%]，近全切[NTR]，n=10[9.9%]，次全切[STR]，n=2[2.0%]）和 LP 组（GTR，n=125[80.1%]；NTR，n=24[15.4%]；STR，n=7[4.5%]）之间的切除程度无显著差异。术后 8 天，SSP 组面神经（FN）功能保留的 GTR 率高于 LP 组（P=0.014）。然而，在随访期间（SSP 组中位数，31.5 个月；LP 组中位数，19.5 个月），两组之间 FN 功能保留没有显著差异。两名 SSP 组患者因术中严重静脉空气栓塞（VAE）需要转为 LP。
与 LP 相比，SSP 并未在大型 VS 患者中产生明显更好的 FN 结果。SSP 病例的手术时间明显长于 LP 病例。鉴于 SSP 相关的 VAE 风险，应谨慎选择最佳手术体位。
