Beyond audiofacial morbidity after vestibular schwannoma surgery Clinical article
Beyond audiofacial morbidity after vestibular schwannoma surgery Clinical article
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DOI：
10.3171/2009.10.jns091203
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发表时间：
2011-02-01
影响因子：
4.1
通讯作者：
Parsa, Andrew T.
中科院分区：
文献类型：
--
作者：
Sughrue, Michael E.;Yang, Isaac;Parsa, Andrew T.
对象。前庭神经鞘瘤（VS）手术后的结果已被广泛描述；然而，文献报道的并发症发生率差异很大。此外，大多数报道都集中在与颅神经（CNs） VII和VIII相关的结果上。本研究的目的是分析vsv切除术后与CNs VII和CNs VIII无关的发病率。作者对英文文献进行了全面的检索，确定并汇总了接受显微手术切除VSs的患者的发病率和死亡率数据。基于手术入路和肿瘤大小进行亚组分析，比较脑脊液漏、血管损伤、神经功能缺损和术后感染的发生率。100篇文章符合纳入标准，提供了32,870例患者的数据。总死亡率为0.2% （95% CI 0.1-0.3%）。22%的患者（95% CI 21-23%）经历了至少1个与CNs VII或CNs VIII无关的手术并发症。8.5%的患者发生脑脊液漏（95% CI 6.9-10.0%）。经迷路入路明显增加，但不受肿瘤大小的影响。1%的患者出现血管并发症，如缺血性损伤或出血（95% CI 0.75-1.2%）。8.6%的病例发生神经系统并发症（95% CI 7.9-9.3%），切除较小肿瘤（p < 0.0001）和经迷路入路（p < 0.0001）的可能性较小。3.8%的病例发生感染（95% CI 3.4-4.3%），其中78%的感染为脑膜炎。本研究为从业人员提供了强有力的统计数据，以告知患者与中枢第七和第八神经受损无关的VS手术风险。(DOI: 10.3171 / 2009.10.jns091203)
Object. Outcomes following vestibular schwannoma (VS) surgery have been extensively described; however, complication rates reported in the literature vary markedly. In addition, the majority of reports have focused on outcomes related to cranial nerves (CNs) VII and VIII. The objective of this study was to analyze reported morbidity unrelated to CNs VII and VIII following the resection of VS.Methods. The authors performed a comprehensive search of the English language literature, identifying and aggregating morbidity and death data from patients who had undergone microsurgical removal of VSs. A subgroup analysis based on surgical approach and tumor size was performed to compare rates of CSF leakage, vascular injury, neurological deficit, and postoperative infection.Results. One hundred articles met the inclusion criteria, providing data for 32,870 patients. The overall mortality rate was 0.2% (95% CI 0.1-0.3%). Twenty-two percent of patients (95% CI 21-23%) experienced at least 1 surgically attributable complication unrelated to CNs VII or VIII. Cerebrospinal fluid leakage occurred in 8.5% of patients (95% CI 6.9-10.0%). This rate was markedly increased with the translabyrinthine approach but was not affected by tumor size. Vascular complications, such as ischemic injury or hemorrhage, occurred in 1% of patients (95% CI 0.75-1.2%). Neurological complications occurred in 8.6% of cases (95% CI 7.9-9.3%) and were less likely with the resection of smaller tumors (p < 0.0001) and the use of the translabyrinthine approach (p < 0.0001). Infections occurred in 3.8% of cases (95% CI 3.4-4.3%), and 78% of these infections were meningitis.Conclusions. This study provides statistically powerful data for practitioners to advise patients about the published risks of surgery for VS unrelated to compromised CNs VII and VIII. (DOI: 10.3171/2009.10.JNS091203)