House Clinic, Los Angeles, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Otolaryngol Head Neck Surg. 2024 Sep;171(3):642-657. doi: 10.1002/ohn.823. Epub 2024 Jun 1.
To evaluate tumor control and facial nerve outcomes after gross-total (GTR), near-total (NTR), and subtotal resection (STR) of sporadic vestibular schwannomas (VS).
PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched in August 2021 through inception following PRISMA guidelines.
English language articles reporting tumor control and facial nerve outcomes of adults (≥18 years) with NTR and STR of VS were evaluated. Study characteristics, demographics data, tumor characteristics, type of surgical intervention, and outcome measures on tumor control and facial nerve function were collected. Pooled relative risk (RR) estimates for tumor recurrence and facial nerve outcomes were calculated and stratified by extent of resection.
From an initial search of 2504 articles, 48 studies were included in the analysis. When comparing 1108 patients who underwent NTR to 3349 patients with GTR, the pooled RR of recurrence in the NTR cohort was 2.94 (95% confidence interval [CI] 1.65-5.24, P = .0002). When comparing 1016 patients who underwent STR to 6171 patients with GTR, the pooled RR of recurrence in the STR cohort was 11.50 (95% CI 6.64-19.92, P < .0001). Estimates for risk of tumor regrowth for less-than-complete resection are presented. There was no elevated risk of adverse facial nerve outcome (defined as House-Brackmann grade III and above) in each category of extent of resection compared to GTR.
Extent of resection predicts risk of tumor recurrence/regrowth following microsurgical resection. Favorable facial nerve outcome should be weighed against the increased risk of regrowth and the potential need for further treatment.
评估散发性前庭神经鞘瘤（VS）全切除（GTR）、近全切除（NTR）和次全切除（STR）后的肿瘤控制和面神经结果。
2021 年 8 月，根据 PRISMA 指南，在 PubMed、Cochrane 对照试验中心注册库、Web of Science 和 Scopus 数据库中进行了搜索，检索范围为建库至 2021 年 8 月。
评估了报告 NTR 和 STR 成人（≥18 岁） VS 肿瘤控制和面神经结果的英语语言文章。收集了研究特征、人口统计学数据、肿瘤特征、手术干预类型以及肿瘤控制和面神经功能的结果测量。计算了肿瘤复发和面神经结果的汇总相对风险（RR）估计值，并按切除范围进行分层。
从最初的 2504 篇文章中搜索，共有 48 项研究纳入分析。将 1108 例接受 NTR 的患者与 3349 例接受 GTR 的患者进行比较，NTR 组的复发 RR 为 2.94（95%置信区间 [CI] 1.65-5.24，P=0.0002）。将 1016 例接受 STR 的患者与 6171 例接受 GTR 的患者进行比较，STR 组的复发 RR 为 11.50（95%CI 6.64-19.92，P<0.0001）。提出了不完全切除肿瘤复发风险的估计值。与 GTR 相比，在每个切除范围类别中，都没有面神经不良结局（定义为 House-Brackmann 分级 III 及以上）的风险增加。
切除范围预测显微切除后肿瘤复发/生长的风险。面神经功能的良好预后应权衡复发风险的增加以及进一步治疗的潜在需要。
