Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach
Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach
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DOI：
10.1016/j.wneu.2016.12.055
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发表时间：
2017-03-01
影响因子：
2
通讯作者：
Mao, Ying
中科院分区：
文献类型：
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作者：
Huang, Xiang;Xu, Ming;Mao, Ying
目的：探讨经枕下乙状窦后入路显微手术治疗颅内大前庭神经鞘瘤（VS）的常见并发症，并提出减少并发症的对策。方法：我们从收集的数据库（1999-2013）中选择所有接受显微手术切除作为组织病理学证实的VS初始治疗的大单侧VS患者，肿瘤大于30 ~ 20 mm被定义为大。结果：共纳入1167例VS患者。1006例（86.2%）患者全部切除肿瘤。死亡率为0.77%。解剖上保留面神经1083例（92.8%），术后根据us - brackmann量表进行面神经功能评价，I-II级423例（36.2%），III级534例（45.8%），IV-VI级210例（18.0%）。术后短期主要并发症包括新发听力损失634例（54.3%），听力失衡250例（21.4%），唇疱疹127例（10.9%），脑膜炎115例（9.85%），下颅神经缺损77例（6.59%）。1167例患者中有978例（83.8%）可获得随访数据。长期并发症包括听力损失（美国耳鼻喉头颈外科学会分级D级）（75.8%）、永久性面瘫（11.9%）、面部麻木（10.9%）、耳鸣（2.96%）、慢性头痛（2.25%）和味觉障碍（1.43%）。结论：术前仔细评估听神经和面神经的功能，深入了解乙状窦后入路的解剖结构，熟练的显微外科技术，在切除过程中监测多颅神经，是减少手术并发症的关键因素。
OBJECTIVE: To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.METHODS: We selected all patients with large unilateral VS from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30 Chi 20 mm were defined as large.RESULTS: A total of 1167 patients with VS were included. Gross total tumor resection was achieved in 1006 patients (86.2%). The mortality rate is 0.77%. The facial nerve was preserved anatomically in 1083 cases (92.8%), and the functional valuation of the facial nerve according to postoperative House-Brackmann scale showed 423 patients (36.2%) in grades I-II, 534 cases (45.8%) in grade III, and 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included new hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) in 634 cases (54.3%), disequilibrium in 250 cases (21.4%), labial herpes in 127 cases (10.9%), meningitis in 115 (9.85%) and lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term complications include hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) (75.8%), permanent facial paralysis (11.9%), facial numbness (10.9%), tinnitus (2.96%), chronic headache (2.25%), and taste disturbance (1.43%).CONCLUSIONS: The key factors for reducing surgical complications include careful assessment of the functions of acoustic and facial nerves as well as a thorough understanding of anatomy via the retrosigmoid approach before operation, skillful microsurgical technique, and monitoring of multiple cranial nerves during resection.