Microsurgical removal of vestibular schwannomas after failed previous microsurgery.
Microsurgical removal of vestibular schwannomas after failed previous microsurgery.
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DOI：
10.1159/000156903
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发表时间：
2008-01-01
影响因子：
--
通讯作者：
Thomassin, Jean-Marc
中科院分区：
文献类型：
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作者：
Roche, Pierre-Hugues;Khalil, Muhamad;Thomassin, Jean-Marc
复发和再生的大型前庭神经鞘瘤(VSS)可能需要另一种显微外科手术。人们对第二次手术的发生率和后果知之甚少。我们回顾了20年来我们自己的10个再手术病例。其中8人一开始就应该接受根治性手术，而2人已经经历了次全切除。两次手术的平均间隔为8.3年，超晚期复发病例为20年。根据主要病例中的大型肿瘤生长和/或新症状的出现，额外手术是合理的。我们采用扩大的经迷路入路9例，乙状窦后入路1例。6例面神经运动良好(H-B、GdI或II级)的患者中，3例获得了良好的面神经运动功能。除面神经损伤外，无重大并发症发生。这些结果证实，反复手术治疗VS在保留功能方面存在额外的困难。鉴于放射外科是控制中小型VSS的有效手段，近年来，在手术切除复发和再生的VSS时，优先考虑面神经的保护。
Recurrent and regrowing large vestibular schwannomas (VSs) may require another microsurgical procedure. Little is known about the incidence and the consequences of this second surgical procedure. We reviewed our own 10 reoperated cases during a 20-year period. Eight of them were supposed to have a radical surgery at the initial step, while 2 had experienced a subtotal resection. The mean interval between the 2 surgeries was 8.3 years with an ultra-late recurrent case at 20 years. Additional surgery was justified by a large-sized growing tumor in main cases and/or occurrence of new symptoms. We used a widened translabyrinthine approach in 9 cases and a retrosigmoid route in 1 case. Preservation of a good facial nerve motion (H-B gd I or II) was obtained in 3 out of the 6 cases who displayed this preoperative status. Excluding the facial nerve injury, no major complication was observed in these cases. These results confirm that the iterative surgical procedure for VS carries additional difficulties with respect to functional preservation. Assuming that radiosurgery is an effective tool to control small- to middle-sized VSs, priority was recently given to the facial nerve preservation during the surgical removal of recurrent and regrowing VSs.