Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, No.1 Xin Si Road, 710038, Xi'an, Shaanxi Province, China.
Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi'an, China.
J Neurooncol. 2023 Jun;163(2):429-437. doi: 10.1007/s11060-023-04330-6. Epub 2023 May 24.
To compare the clinical outcomes of large or giant vestibular schwannomas (VSs) between older patients and younger patients who underwent microsurgery and to explore whether the incidence of postoperative complications increased and whether the postoperative hospital stay was prolonged.
We conducted a retrospective matched cohort study based on the surgical approach, maximum tumor diameter and extent of resection. Older patients (≥ 60 years) and a matched group (<60 years) who had undergone microsurgery for VSs between January 2015 and December 2021 were included. Clinical data, surgical outcomes and postoperative complications were analyzed statistically.
Forty-two older patients (≥ 60 years, 66.0 ± 3.8 years) were identified and matched to younger patients (<60 years, 43.9 ± 11.2 years), and they all underwent microsurgery through a retrosigmoid approach. There were twenty-nine patients with 3-4 cm VSs and thirteen patients with > 4 cm VSs in both groups. The older patients had a higher proportion of imbalance (P = 0.016) and lower American Society of Anesthesiology scores (P = 0.003) before surgery than the younger patients. There was no significant difference in facial nerve function one week (p = 0.851) and one year (p = 0.756) after surgery and no difference in the postoperative complication incidence (40.5% vs. 23.8%, p = 0.102) between the older patients and controls. Furthermore, the older patients had longer postoperative hospital stays than the younger patients (p = 0.043). In the older group, six patients with near total resection and five with subtotal resection were administered stereotactic radiotherapy, and one had recurrence three years after surgery and received conservative treatment. The postoperative follow-up time ranged from 1 to 83 months, with an average of 33.5 ± 21.1 months.
For older patients (≥ 60 years) with symptomatic, large or giant -VSs, microsurgery is the only effective method to prolong lifespan, alleviate clinical symptoms and cure the tumor. However, radical resection of VSs may result in a decreased preservation rate of facial-acoustic nerve function and an increased postoperative complication incidence. Therefore, subtotal resection followed by stereotactic radiotherapy should be recommended.
比较接受显微手术治疗的老年和年轻大型或巨大前庭神经鞘瘤（VSs）患者的临床结局，并探讨术后并发症发生率是否增加以及术后住院时间是否延长。
我们进行了一项基于手术入路、最大肿瘤直径和切除程度的回顾性匹配队列研究。纳入 2015 年 1 月至 2021 年 12 月接受 VSs 显微手术治疗的老年患者（≥60 岁）和匹配组（＜60 岁）。统计分析临床资料、手术结果和术后并发症。
共确定 42 例老年患者（≥60 岁，66.0±3.8 岁）并与年轻患者（＜60 岁，43.9±11.2 岁）相匹配，均经乙状窦后入路行显微手术。两组均有 29 例 3-4cm VSs 和 13 例＞4cm VSs。术前老年患者平衡障碍发生率较高（P=0.016），美国麻醉医师协会评分较低（P=0.003）。术后 1 周（p=0.851）和 1 年（p=0.756）面神经功能无显著差异，老年患者与对照组术后并发症发生率无差异（40.5%比 23.8%，p=0.102）。此外，老年患者术后住院时间长于年轻患者（p=0.043）。在老年组中，6 例近全切除患者和 5 例次全切除患者接受立体定向放疗，1 例患者术后 3 年复发，行保守治疗。术后随访时间为 1-83 个月，平均 33.5±21.1 个月。
对于有症状的大型或巨大 VSs 的老年患者（≥60 岁），显微手术是延长寿命、缓解临床症状和治愈肿瘤的唯一有效方法。然而，VSs 的根治性切除可能导致面神经功能保存率降低，术后并发症发生率增加。因此，建议行次全切除后行立体定向放疗。
