Hudelist Benoit, Alciato Lauranne, Bernardeschi Daniele, Kalamarides Michel
Sorbonne Université, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Paris, France.
Department of Neurosurgery, GHU Pitié-Salpétrière, Paris, France.
Neurosurg Rev. 2025 Jan 31;48(1):122. doi: 10.1007/s10143-025-03239-0.
Vestibular schwannoma (VS) is a benign tumor that varies in size and presentation. Surgery is the preferred treatment for large or symptomatic VS. Facial nerve (FN) preservation is a priority because of its impact on well-being. Despite advances in surgical technics and experience, 6% to 20% of patients still experience poor facial function post-surgery. Balancing FN preservation with tumor resection is challenging because residual tumors > 0.6 cm may grow further. Our center has refined its approach to prioritize FN function. This retrospective study evaluated outcomes of our last 100 consecutive cases of VS resection and outlines our current therapeutic indications. We included the last 100 consecutive cases of VS undergoing surgery from January 2022 to December 2023. Exclusion criteria included neurofibromatosis type 2-related schwannomatosis, recurrent VS surgery and radiosurgery, or pre-operative FN palsy. The mean tumor volume was 8.8 ± 0.6 cm, corresponding to 1 case of KOOS grade 2, 19 cases of KOOS grade 3, and 80 cases of KOOS grade 4. Overall, 85 patients underwent surgery with a retrosigmoid approach; 33 cases exhibited a complex FN course that was challenging during tumor removal. Resection quality was assessed as gross total resection in 17 patients (no tumor remaining, not visible on MRI), near total resection in 22 (few tumor remaining, not visible on MRI), subtotal resection in 52 (residual tumor ≤ 0.5 cm on MRI), and partial resection in 9 (residual tumor ≥ 0.6 cm on MRI). In total, 94 patients had good FN function (grade I or II) immediately after surgery and 98 patients at last follow-up. Our experience with the last 100 consecutive VS surgeries highlights our revised policy to prioritize FN function, despite some minor residual tumor remaining of which only a few grow and will be treated by radiosurgery.
前庭神经鞘瘤（VS）是一种大小和表现各异的良性肿瘤。手术是大型或有症状VS的首选治疗方法。由于面神经（FN）对患者生活质量有影响，保留面神经是首要任务。尽管手术技术和经验有所进步，但仍有6%至20%的患者术后面部功能不佳。在保留面神经与切除肿瘤之间取得平衡具有挑战性，因为残留肿瘤>0.6 cm可能会进一步生长。我们中心改进了方法，将面神经功能置于优先地位。这项回顾性研究评估了我们最近连续100例VS切除术的结果，并概述了我们目前的治疗指征。我们纳入了2022年1月至2023年12月期间连续接受手术的最后100例VS病例。排除标准包括2型神经纤维瘤病相关的神经鞘瘤病、复发性VS手术和放射外科手术，或术前FN麻痹。平均肿瘤体积为8.8±0.6 cm，对应1例KOOS 2级、19例KOOS 3级和80例KOOS 4级。总体而言，85例患者采用乙状窦后入路进行手术；33例患者的FN走行复杂，在肿瘤切除过程中具有挑战性。切除质量评估为17例患者为全切除（无肿瘤残留，MRI上不可见），22例为近全切除（残留少量肿瘤，MRI上不可见），52例为次全切除（MRI上残留肿瘤≤0.5 cm），9例为部分切除（MRI上残留肿瘤≥0.6 cm）。总共有94例患者术后立即具有良好的FN功能（I级或II级），98例患者在最后一次随访时具有良好的FN功能。我们最近连续100例VS手术的经验突出了我们将FN功能置于优先地位的修订政策，尽管仍有一些小的残留肿瘤，其中只有少数会生长并将接受放射外科治疗。
