Moshtaghi Omid, Barba Patrick, Dixon Peter, Ren Yin, Schwartz Marc, Friedman Rick
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, United States.
Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, United States.
J Neurol Surg B Skull Base. 2024 Apr 25;86(2):229-233. doi: 10.1055/a-2297-3849. eCollection 2025 Apr.
The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection. Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House-Brackmann facial nerve grading, and completeness of resection were prospectively recorded. Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51-63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05-0.53, = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size. Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.
本研究的目的是评估最初采用现代放疗技术治疗的前庭神经鞘瘤（VS）挽救性显微手术后的临床结果，并与原发性显微手术切除治疗的结果进行比较。纳入在单一学术性颅底三级转诊中心接受经迷路入路显微手术切除散发性VS的患者。前瞻性记录基线和术后动态步态指数、功能性步态评估、House-Brackmann面神经分级以及切除的完整性。在审查的265例患者中，21例（7.9%）曾接受过放疗。该队列的中位年龄为55岁（四分位间距：51 - 63岁）。在控制肿瘤大小的情况下，接受过放疗的患者实现全切除的可能性显著低于未接受放疗的患者（比值比：0.18，95%置信区间：0.05 - 0.53，P = 0.004）。接受过放疗的患者在术后第一天的面神经功能较好，但在长期随访中这种差异并不显著。在功能性步态评估（FGA）中，接受过放疗的患者术前姿势稳定性得分低于未接受放疗的患者（26分对23分，P = 0.035）。在控制年龄和肿瘤大小后，接受过放疗的患者术后结果与未接受放疗的患者相当。与仅接受手术治疗的VS患者相比，先前接受过放疗的患者在挽救性手术中实现全切除的可能性较小。接受过放疗的患者在术后初期面神经结果评分优于未接受放疗的患者，但长期结果相似。
