前庭神经鞘瘤切除术后肿瘤内或肿瘤周围血肿。

Postoperative Intratumoral or Peritumoral Hematomas After Vestibular Schwannoma Resection.

机构信息

Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.

Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

出版信息

Acta Neurochir Suppl. 2023;130:47-52. doi: 10.1007/978-3-030-12887-6_7.

DOI:10.1007/978-3-030-12887-6_7

PMID:37548723

Abstract

BACKGROUND

Surgical removal of a vestibular schwannoma is a complex and challenging procedure, which may be complicated by development of postoperative hematomas, particularly after incomplete resection of the tumor.

OBJECTIVE

To investigate the occurrence of postoperative intra- or peritumoral hematomas after surgery for a vestibular schwannoma.

METHODS

This retrospective study evaluated 49 patients (age range 17-78 years) with a vestibular schwannoma, who were treated surgically via the lateral suboccipital approach between 2011 and 2016. The tumors ranged in size from 0 mm (in a case of an intracanalicular lesion) to 56 mm. In 30 cases (61%), total or near-total resection was accomplished, and in 19 cases (39%), subtotal or partial resection was done. On the basis of their bleeding tendency during tumor removal, the patients were divided into a "less-bleeding" (38 cases; 78%) and a "more-bleeding" (11 cases; 22%) subgroups.

RESULTS

A maximal vestibular schwannoma diameter >30 mm, patient age >60 years, and more bleeding during tumor removal were significantly associated with incomplete (subtotal or partial) resection. In six cases (12%), serial computed tomography after surgery demonstrated a postoperative hematoma, which was caused by insufficient irrigation of the surgical field (in two cases) or resulted from peritumoral hemorrhage (in two cases), intratumoral hemorrhage (in one case), or both intra- and peritumoral hemorrhage (in one case). The latter patient required urgent reoperation. In all cases, postoperative hematomas occurred after incomplete (subtotal or partial) resection of a vestibular schwannoma, and their development was significantly associated with more bleeding during tumor removal.

CONCLUSION

For avoidance of postoperative hematomas, careful hemostasis is required after completion of vestibular schwannoma removal, especially in cases with incomplete resection and an excessive bleeding tendency of the tumor tissue.

摘要

背景

听神经鞘瘤的手术切除是一个复杂且具有挑战性的过程，特别是在肿瘤不完全切除的情况下，可能会出现术后血肿。

目的

探讨听神经鞘瘤术后发生颅内或肿瘤内血肿的情况。

方法

本回顾性研究评估了 2011 年至 2016 年间通过外侧枕下入路手术治疗的 49 例（年龄 17-78 岁）听神经鞘瘤患者。肿瘤大小从 0 毫米（一例为管内病变）至 56 毫米不等。在 30 例（61%）中完成了全切除或近全切除，在 19 例（39%）中完成了次全切除或部分切除。根据肿瘤切除过程中的出血倾向，将患者分为“出血较少”（38 例；78%）和“出血较多”（11 例；22%）亚组。

结果

最大听神经鞘瘤直径>30 毫米、患者年龄>60 岁、肿瘤切除时出血较多，与不完全切除（次全或部分）显著相关。术后 6 例（12%）连续 CT 显示术后血肿，其原因为手术野冲洗不充分（2 例）或因肿瘤周围出血（2 例）、肿瘤内出血（1 例）或肿瘤内和周围出血（1 例）所致。后一例患者需要紧急再次手术。所有病例均发生在听神经鞘瘤不完全切除（次全或部分切除）后，且术后血肿的发生与肿瘤切除时出血较多显著相关。