Management of 1000 vestibular schwannomas (acoustic neuromas): Surgical management and results with an emphasis on complications and how to avoid them
Management of 1000 vestibular schwannomas (acoustic neuromas): Surgical management and results with an emphasis on complications and how to avoid them
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DOI：
10.1097/00006123-199701000-00002
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发表时间：
1997-01-01
期刊：
影响因子：
4.8
通讯作者：
Matthies, C
中科院分区：
文献类型：
--
作者：
Samii, M;Matthies, C
目的：为了明确枕下入路治疗前庭神经鞘瘤的实际益处和持续存在的问题，对资深作者手术治疗的1000例肿瘤的连续系列的结果和并发症进行了分析，并与涉及其他治疗方式的经验进行了比较。预处理确定术后临床状态，收集放射学和手术结果，并在大型数据库中评估962结果：经枕下经外耳道入路，肿瘤完全切除979例，其中21例因脑干减压或保留最后一只听力耳的听力而作部分切除。93%的患者面神经解剖保留，68%的患者耳蜗神经解剖保留。主要神经系统并发症包括四肢轻瘫1例，轻偏瘫10例，5.5%的病例出现尾侧颅神经麻痹。手术并发症包括血肿（2.2%）、脑脊液瘘（9.2%）、脑积水（2.3%）、细菌性脑膜炎（1.2%）和伤口翻修（1.1%）。术后2 ~ 69天死亡11例（1.1%）。报告了为避免并发症而开发的技术。该分析确定了预先存在的严重的一般和/或神经系统的发病率，囊性肿瘤形成，和主要的尾侧颅神经缺损为相关的风险factors.CONCLUSION：目前的治疗选择，完全切除肿瘤的发病率不断降低，以及由枕下入路。通过仔细选择患者，死亡率应进一步降至1%以下。
OBJECTIVE: To identify the actual benefits and persisting problems in treating vestibular schwannomas by the suboccipital approach, the results and complications in a consecutive series of 1000 tumors surgically treated by the senior author were analyzed and compared with experiences involving other treatment modalities.METHODS: Pre- and postoperative clinical statuses were determined and radiological and surgical findings were collected and evaluated in a large database for 962 patients undergoing 1000 vestibular schwannoma operations at Nordstadt's neurosurgical department from 1978 to 1993.RESULTS: By the suboccipital transmeatal approach, 979 tumors were completely removed; in 21 cases, deliberate partial removal was performed either in severely ill patients for decompression of the brain stem or in an attempt to preserve hearing in the last hearing ear. Anatomic preservation of the facial nerve was achieved in 93% of the patients and of the cochlear nerve in 68%. Major neurological complications included 1 case of tetraparesis, 10 cases of hemiparesis, and caudal cranial nerve palsies in 5.5% of the cases. Surgical complications included hematomas in 2.2% of the cases, cerebrospinal fluid fistulas in 9.2%, hydrocephalus in 2.3%, bacterial meningitis in 1.2%, and wound revisions in 1.1%. There were 11 deaths occurring at 2 to 69 days postoperatively (1.1%). The techniques that were developed for avoidance of complications are reported. The analysis identifies preexisting severe general and/or neurological morbidity, cystic tumor formation, and major caudal cranial nerve deficits as relevant risk factors.CONCLUSION: The current treatment options of complete tumor resection with ongoing reduction of morbidity are well fulfilled by the suboccipital approach. By careful patient selection, the mortality rate should be further reduced to below 1%.