S. Rujimethapass, Anant Ananthanandorn, K. Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant
{"title":"大前庭神经鞘瘤全切除或次全切除后的手术结果:单一机构的经验","authors":"S. Rujimethapass, Anant Ananthanandorn, K. Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant","doi":"10.14791/btrt.2021.0028","DOIUrl":null,"url":null,"abstract":"Background Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection. Methods Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis. Results The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001). Conclusion In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience\",\"authors\":\"S. Rujimethapass, Anant Ananthanandorn, K. Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant\",\"doi\":\"10.14791/btrt.2021.0028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection. Methods Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis. Results The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001). Conclusion In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.\",\"PeriodicalId\":72453,\"journal\":{\"name\":\"Brain tumor research and treatment\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brain tumor research and treatment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14791/btrt.2021.0028\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain tumor research and treatment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14791/btrt.2021.0028","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:大前庭神经鞘瘤患者的手术结果各不相同。本研究的目的是评估面神经全切和次全切患者的预后和手术并发症。方法2008年10月至2020年9月,72例患者在Rajavithi医院接受手术治疗。其中48例全部或次全切除。我们将这些参与者分为两组:VS≥3 cm (A组,n=30);VS <3 cm (B组,n=18)。比较两组患者的临床表现、影像学资料、面神经预后和手术并发症。每个病例均采用乙状结肠后入路,所有患者随访至少1年。采用卡方检验和Fisher精确检验进行统计分析。结果A组平均肿瘤大小为3.8 cm, b组为1.5 cm。A组96.7%、66.7%、50%的患者出现听力障碍、步态共济失调、面部感觉异常的临床症状,b组为100%、5.6%、11.1%。40%的大VS患者和94.4%的中小型VS患者面神经预后良好(House-Brackmann [HB]面部评分量表I-III级)。两组仅在步态共济失调(p<0.001)、面部感觉异常(p=0.006)、脑积水影像学征象(p=0.002)、面神经预后1个月(p<0.001)和面神经预后1年(p<0.001)方面存在显著差异。结论在大尺寸VS患者中,显微手术切除的面神经预后较中小尺寸VS差,计划的次全切除配合术后放射手术可能获得更好的面神经预后,并改善大尺寸VS患者的生活质量。
Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience
Background Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection. Methods Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis. Results The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001). Conclusion In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.