Departments of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
Departments of Radiology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
Acta Neurochir (Wien). 2023 Jul;165(7):1749-1755. doi: 10.1007/s00701-023-05627-1. Epub 2023 May 18.
Large (> 3 cm) vestibular schwannomas pose complexity in surgical management because of narrow working corridors and proximity to the cranial nerves, brainstem, and inner ear structures. With current vestibular schwannoma classifications limited in information regarding cerebellopontine edema, our retrospective series examined this radiographic feature relative to clinical outcomes and its possible role in preoperative scoring.
Of 230 patients who underwent surgical resection of vestibular schwannoma (2014-2020), we identified 107 patients with Koos grades 3 or 4 tumors for radiographic assessment of edema in the middle cerebellar peduncle (MCP), brainstem, or both. Radiographic images were graded and patients grouped into Koos grades 3 or 4 or our proposed grade 5 with edema. Tumor volumes, radiographic features, clinical presentations, and clinical outcomes were evaluated.
The 107 patients included 22 patients with grade 3 tumors, 39 with grade 4, and 46 with grade 5. No statistical differences were noted among groups for demographic data or complication rates. Unlike grades 3 and 4 patients, grade 5 patients presented with worse hearing (p < 0.001), larger tumors (p < 0.001), lower rates of gross total resection (GTR), longer hospital stays, and higher rates of balance dysfunction.
With edema detected in 43% of this cohort, special considerations are warranted for grade 5 vestibular schwannomas given the preoperative findings of worse hearing, lower GTR rates, longer hospital stays, and 96% who pursued postoperative balance therapy. We propose that grade 5 with edema offers a more nuanced interpretation of a radiographic feature that holds relevance to treatment selection and patient outcomes.
由于工作通道狭窄且靠近颅神经、脑干和内耳结构，因此 > 3 cm 的大型前庭神经鞘瘤在手术管理方面存在复杂性。由于目前的前庭神经鞘瘤分类在小脑脑桥水肿方面的信息有限，我们的回顾性系列研究检查了这种放射学特征与临床结果及其在术前评分中的可能作用。
在 2014 年至 2020 年间接受前庭神经鞘瘤手术切除的 230 名患者中，我们确定了 107 名 Koos 分级为 3 或 4 级的患者，对中脑小脑脚（MCP）、脑干或两者的水肿进行放射学评估。对放射图像进行分级，并将患者分为 Koos 分级 3 或 4 级或我们提出的 5 级伴水肿。评估了肿瘤体积、放射学特征、临床表现和临床结果。
107 名患者中，22 名患者为 3 级肿瘤，39 名患者为 4 级肿瘤，46 名患者为 5 级肿瘤。各组在人口统计学数据或并发症发生率方面无统计学差异。与 3 级和 4 级患者不同，5 级患者的听力更差（p < 0.001），肿瘤更大（p < 0.001），全切率（GTR）较低，住院时间较长，平衡功能障碍发生率较高。
在该队列中，43%的患者检测到水肿，鉴于术前发现听力更差、GTR 率较低、住院时间较长以及 96%的患者接受术后平衡治疗，5 级伴水肿的患者需要特别考虑。我们提出，5 级伴水肿提供了对放射学特征的更细致解释，该特征与治疗选择和患者结果相关。
