大型前庭神经鞘瘤全切或次全切术后的手术结果：单机构经验

Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience.

作者信息

Rujimethapass Sujin, Ananthanandorn Anant, Karnchanapandh Krissanee, Wongsirisuwan Mathee, Gunnarat Ittipon, Segkhaphant Noppatee

机构信息

Division of Neurosurgery, Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.

出版信息

Brain Tumor Res Treat. 2022 Apr;10(2):108-112. doi: 10.14791/btrt.2021.0028.

DOI:10.14791/btrt.2021.0028

PMID:35545830

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9098976/

Abstract

BACKGROUND

Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection.

METHODS

Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher's exact test were used for statistical analysis.

RESULTS

The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (<0.001), facial paresthesia (=0.006), radiographic signs of hydrocephalus (=0.002), facial nerve outcome 1 month (<0.001) and facial nerve outcome 1 year (<0.001).

CONCLUSION

In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.

摘要

背景

大型前庭神经鞘瘤患者有多种手术结果。本研究的目的是评估接受全切和次全切的患者的面神经结果及手术并发症。

方法

2008年10月至2020年9月期间，72例患者在拉贾维提医院接受手术。其中，48例接受了全切或次全切。我们将这些参与者分为两组：前庭神经鞘瘤≥3 cm（A组，n = 30）；前庭神经鞘瘤<3 cm（B组，n = 18）。比较两组患者的临床表现、影像学数据、面神经结果和手术并发症。每例均采用乙状窦后入路，所有患者均随访至少1年。采用卡方检验和Fisher精确检验进行统计分析。

结果

A组肿瘤平均大小为3.8 cm，而B组为1.5 cm。A组中，分别有96.7%、66.7%、50%的患者出现听力功能障碍、步态共济失调和面部感觉异常的临床体征，而B组分别为100%、5.6%和11.1%。A组56.7%的受试者观察到脑积水的影像学体征，B组为5.6%。在1年随访时，大型前庭神经鞘瘤患者中40%和中小型前庭神经鞘瘤患者中94.4%的面神经结果良好（House-Brackmann[HB]面神经分级量表I-III级）。两组之间仅在步态共济失调（<0.001）、面部感觉异常（=0.006）、脑积水的影像学体征（=0.002）、1个月时的面神经结果（<0.001）和1年时的面神经结果（<0.001）方面存在显著差异。