Trigeminal neuralgia and neuropathy in large sporadic vestibular schwannomas
Trigeminal neuralgia and neuropathy in large sporadic vestibular schwannomas
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DOI：
10.3171/2016.9.jns16515
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发表时间：
2017-11-01
影响因子：
4.1
通讯作者：
Link, Michael J.
中科院分区：
文献类型：
--
作者：
Neff, Brian A.;Carlson, Matthew L.;Link, Michael J.
目的：本研究的目的是评估伴有三叉神经接触的大型前庭神经鞘瘤（VS）继发三叉神经介导症状的发生率、表现和治疗结果。具体而言，症状的结果疼痛，感觉异常，麻木后显微外科切除术或立体定向放射外科（SRS）examined.METHODS的作者进行了回顾性审查的数据库的伴随诊断三叉神经痛（TN）或三叉神经病变和VS之间的1994年和2014年在一个三级学术中心。除了2型神经纤维瘤病和选择观察的患者外，所有伴有TN或神经病变的VS患者均纳入研究。收集患者人口统计学数据、症状演变和治疗结果。人口数据进行了总结，显微手术和SRS之间的结果比较进行了分析，在最后follow-up.Results六十（2.2%）的2771例总患者谁有大VS和TN或神经病变症状符合纳入标准。三叉神经症状发作的平均年龄为53.6岁（范围24-79岁），VS诊断的平均年龄为54.4岁（范围25-79岁），显微手术组和SRS组的平均随访时间分别为30和59个月（范围3-132个月）。在这些患者中，50例（83%）面部麻木，16例（27%）TN疼痛，13例（22%）感觉异常（即，烧灼感或刺痛感）。随后，50例（83%）患者接受了切除术，10例（17%）患者接受了SRS。SRS治疗VS没有改善任何患者的三叉神经症状。这包括2例面部麻木未改善的受试者和4例麻木加重的患者。同样，SRS加重了5例患者的TN疼痛和感觉异常，并未能改善另外2例患者的疼痛。与显微手术相比，接受SRS的患者的巴罗神经研究所神经痛和感觉迟钝量表评分明显更差，切除减轻了22例（50%）患者的面部麻木，5例（42%）患者的感觉异常，7例（70%）患者的TN。在一些患者中，手术未能成功缓解面部麻木，17例（39%）患者的面部麻木未能改善，5例（11%）患者的面部麻木加重。此外，手术未改变6例（50%）和3例（25%）患者的面部感觉异常或神经痛的强度。显微手术加重面部感觉异常1例（8%），但值得注意的是，没有加重TN在任何patient.CONCLUSIONS总体而言，切除大VSs提供了改善的结果为患者伴随TN，面部感觉异常，麻木与SRS相比。然而，在咨询手术候选人时应谨慎，因为许多患者没有改善。这在术前面部麻木和感觉异常的患者中尤其如此，他们经常报告这些症状在手术后没有改变。
OBJECTIVE The aim of this study was to evaluate the incidence, presentation, and treatment outcomes of trigeminal nerve-mediated symptoms secondary to large vestibular schwannomas (VSs) with trigeminal nerve contact. Specifically, the symptomatic results of pain, paresthesias, and numbness after microsurgical resection or stereotactic radiosurgery (SRS) were examined.METHODS The authors conducted a retrospective review of a database for concomitant diagnosis of trigeminal neuralgia (TN) or trigeminal neuropathy and VS between 1994 and 2014 at a tertiary academic center. All patients with VS with TN or neuropathy were included, with the exception of those patients with neurofibromatosis Type 2 and patients who elected observation. Patient demographic data, symptom evolution, and treatment outcomes were collected. Population data were summarized, and outcome comparisons between microsurgery and SRS were analyzed at last follow-up.RESULTS Sixty (2.2%) of 2771 total patients who had large VSs and either TN or neuropathy symptoms met inclusion criteria. The average age of trigeminal symptom onset was 53.6 years (range 24-79 years), the average age at VS diagnosis was 54.4 years (range 25-79 years), and the average follow-up for the microsurgery and SRS groups was 30 and 59 months, respectively (range 3-132 months). Of these patients, 50 (83%) had facial numbness, 16 (27%) had TN pain, and 13 (22%) had paresthesias (i.e., burning or tingling). Subsequently, 50 (83%) patients underwent resection and 10 (17%) patients received SRS.Treatment of VS with SRS did not improve trigeminal symptoms in any patient. This included 2 subjects with unimproved facial numbness and 4 patients with worsened numbness. Similarly, SRS worsened TN pain and paresthesias in 5 patients and failed to improve pain in 2 additional patients. The Barrow Neurological Institute neuralgia and hypesthesia scale scores were significantly worse for patients undergoing SRS compared with microsurgery.Resection alleviated facial numbness in 22 (50%) patients, paresthesias in 5 (42%) patients, and TN in 7 (70%) patients. In several patients, surgery was not successful in relieving facial numbness, which failed to improve in 17 (39%) cases and became worse in 5 (11%) cases. Also, surgery did not change the intensity of facial paresthesias or neuralgia in 6 (50%) and 3 (25%) patients, respectively. Microsurgery exacerbated facial paresthesias in 1 (8%) patient but, notably, did not aggravate TN in any patient.CONCLUSIONS Overall, resection of large VSs provided improved outcomes for patients with concomitant TN, facial paresthesia, and numbness compared with SRS. However, caution should be used when counseling surgical candidates because a number of patients did not experience improvement. This was especially true in patients with preoperative facial numbness and paresthesias, who frequently reported that these symptoms were unchanged following surgery.