半规管裂修复手术效果：单机构经验
Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience.
作者信息
Mozaffari Khashayar, Ghodrati Farinaz, Pradhan Anjali, Ng Edwin, Ding Kevin, Rana Shivam, Duong Courtney, Anderson Roan N, Enomoto Adam, Sheppard John P, Sun Matthew Z, Phillips H Westley, Yang Isaac, Gopen Quinton
机构信息
Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
出版信息
World Neurosurg. 2021 Dec;156:e408-e414. doi: 10.1016/j.wneu.2021.09.083. Epub 2021 Sep 25.
BACKGROUND
Superior semicircular canal dehiscence (SSCD) is an abnormality of the otic capsule, which normally overlies the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. Given the complexity of the disease, there are patients who experience less favorable surgical outcomes and require revision surgery. The purpose of this study was to report to the rate of postoperative symptomatic improvement in patients who required revision surgery.
METHODS
A retrospective analysis of patients undergoing SSCD surgical repair at a single institution was performed. Information on patient demographics, primary and secondary surgical approaches, surgical outcomes, and follow-up length was collected.
RESULTS
Seventeen patients underwent 20 revision surgeries. There were eleven (65%) females and six (35%) males. Mean age of the cohorts was 50 years (range 30-68 years), and mean follow-up length was 6.8 months (range 0.1-31.1 months). Cerebrospinal fluid leak was noted in 67% of cases. The greatest postoperative symptomatic resolution was reported in oscillopsia (100%), headache (100%), and internal sound amplification (71%), while the least postoperative symptomatic resolution was reported in tinnitus (42%), aural fullness (40%), and dizziness (29%).
CONCLUSIONS
Revision surgery can provide symptomatic improvement in select SSCD patients; however, patients should be cautioned about the possibility of less favorable outcomes than in index surgery. Revision surgeries are associated with a considerably higher rate of perioperative cerebrospinal fluid leak.
背景
上半规管裂（SSCD）是耳囊的一种异常情况，耳囊通常覆盖在上半规管之上。对于有持续且使人衰弱症状的患者，需要进行手术治疗。鉴于该疾病的复杂性，有些患者手术效果欠佳，需要进行翻修手术。本研究的目的是报告需要翻修手术的患者术后症状改善的比例。
方法
对在单一机构接受SSCD手术修复的患者进行回顾性分析。收集了患者人口统计学信息、初次和二次手术方法、手术结果以及随访时长。
结果
17例患者接受了20次翻修手术。其中女性11例（65%），男性6例（35%）。患者队列的平均年龄为50岁（范围30 - 68岁），平均随访时长为6.8个月（范围0.1 - 31.1个月）。67%的病例出现脑脊液漏。术后症状缓解最明显的是视振荡（100%）、头痛（100%）和耳内声音放大（71%），而术后症状缓解最不明显的是耳鸣（42%）、耳闷胀感（40%）和头晕（29%）。
结论
翻修手术可以使部分SSCD患者的症状得到改善；然而，应告知患者，其手术效果可能不如初次手术。翻修手术围手术期脑脊液漏的发生率要高得多。
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