Halalmeh Dia R, Asad Mahmoud Y, Atallah Omar A, Sbeih Asil I, Alrashdan Mohammad, Richardson Angela M, Moisi Marc D, Sbeih Ibrahim A
Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
World Neurosurg. 2023 Nov;179:204-215.e4. doi: 10.1016/j.wneu.2023.08.100. Epub 2023 Aug 29.
Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined.
To characterize clinical features of AN schwannomas and predictors of surgical outcomes.
PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes.
A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040).
AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
展神经（AN）神经鞘瘤是极为罕见的肿瘤。其临床特征及影响术后预后的因素尚未明确界定。
描述展神经神经鞘瘤的临床特征及手术预后的预测因素。
按照PRISMA指南对展神经神经鞘瘤的文献进行系统综述。随后，进行单因素和多因素回归分析，以确定影响术后预后的变量的预测价值。
共评估了42项研究中的55例患者。就诊时的平均年龄为43.9±14.6岁。最常见的就诊症状是第六颅神经麻痹（69.1%）。海绵窦（49.1%）和脑桥前池（36.3%）是最常受累的部位。在中位随访时间为28.4±25.8个月时，36.3%的患者术后完全恢复。术前展神经麻痹（P<0.001）、枕下入路（P=0.007）和肿瘤次全切除（P=0.044）是术后并发症的显著保护因素。脑桥前部位和术后并发症是展神经恢复的不良预后指标（优势比[OR]分别为0.10，P=0.030和OR，0.10，P=0.028）。次全切除与展神经恢复的较高几率显著相关（OR，6.06；P=0.040）。
展神经神经鞘瘤虽罕见但严重，可导致显著的发病率，术后仅有约三分之一的患者完全恢复。枕下入路是术后并发症的保护因素，尤其是与次全切除联合时。了解这些因素以及肿瘤特征有助于优化手术规划和术前咨询。
