Functional outcome after complete surgical removal of giant vestibular schwannomas Clinical article
Functional outcome after complete surgical removal of giant vestibular schwannomas Clinical article
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DOI：
10.3171/2009.7.jns0989
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发表时间：
2010-04-01
影响因子：
4.1
通讯作者：
Samii, Amir
中科院分区：
文献类型：
--
作者：
Samii, Madjid;Gerganov, Venelin M.;Samii, Amir
物体。作者评价了一系列巨型前庭神经鞘瘤(VSS)患者根治性手术的结果。50例VSS和GT；最大外径为4.0 cm的患者被纳入这项回顾研究(A组)。将这组患者与167名VSS<；3.9 cm患者(B组)进行比较。所有病例均采用乙状窦后入路。观察指标包括肿瘤切除的完全性、面神经功能、听力和手术相关并发症发生率。肿瘤平均直径A组为4.4 cm，B组为2.3 cm。所有A组患者和97.6%的B组患者均获得全切除。A组和B组的面神经解剖完好率分别为92%和98.8%。术后随访，巨大型VSS患者面神经功能优良率为75%，一般为19%，功能较差为6%。33%的患者(3例)术前听力恢复良好。3例出现新的下颅神经功能障碍，其中2例为暂时性。在那些以前没有接受过手术的人中，有6%的人发生了脑脊液漏。与B组比较，面神经功能优良率、听力良好率、颅神经功能减退率、采血率差异均有统计学意义(P<；0.05)。两组围手术期死亡率均为0%。在巨大VS患者中，经乙状窦后入路可实现肿瘤全切除，死亡率为0%，并发症发生率低，尤其是面神经功能方面。在某些情况下，甚至可以保留听力。肿瘤大小与术后结果显著相关。(DOI：10.3171/2009.7.JNS0989)
Object. The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs).Methods. Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate.Results. The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B. a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%.Conclusions. In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome. (DOI: 10.3171/2009.7.JNS0989)