10年单中心听神经瘤患者手术治疗回顾性研究

目的回顾性分析本中心手术治疗的听神经瘤患者,对临床特点、术前影像学、手术切除率、术后神经功能状态及术后并发症进行统计分析,并借此探讨听神经瘤患者的规范外科治疗策略。方法:回顾性分析自2007年6月至2017年6月于本中心接受外科治疗的单侧听神经瘤患者,统计分析患者一般资料,肿瘤大小、手术时间,术中出血量、肿瘤切除率、神经功能评估、术前(后)听力学检查及术后并发症等数据,并对上述各项数据进行多元逻辑回归分析。探讨肿瘤大小与手术时间、术中出血量及术后并发症之间的关系。结果:根据纳入排除标准,共有557名患者进入本研究,手术均采用枕下乙状窦后入路,患者平均年龄45.8±10.8岁;其中男性230例(37.7%);肿瘤直径≥3cm者468例(84.0%);平均手术时间5.2±1.8小时;术中出血量337±145ml;肿瘤达全切者513例(92.1%),次全切者44例(7.9%);518例患者达到术中面神经解剖保留(93.0%);术后House-Brackmann分级评估面神经功能Ⅰ-Ⅲ级者471例(84.6%);术前听力可用者41例,术后听力可用者12例(29.3%)。术后发生脑脊液漏者16例(2.9%),发生术侧面部麻木者12例(2.2%),出现复视者18例(3.2%),出现后组颅神经麻痹症状者15例(2.7%),术后颅内出血者5例(0.9%)。校正多元逻辑回归分析结果显示,肿瘤大小与手术时间、术中出血量、术后面瘫及复视发生率之间呈正相关关系(P<0.05),当肿瘤最大直径>5cm时,术中出血量显著增加(P<0.05)。结论:单侧听神经瘤患者手术治疗的难点是术中神经功能的保护。减少手术操作的机械损伤、运用术中神经电生理监测技术对提高治疗效果十分关键。肿瘤大小与手术时间、术中出血量及术后神经功能障碍发生率呈正相关关系。

Summary of Vestibular Schwannoma Cases treated with Microsurgery: Ten Years Experiences at a Single-Center

Objective To review authors’experience with cases of vestibular schwannoma(VS)treated with microsurgery at the Department of Neurosurgery,PLA General Hospital,in the past 10 years for the purpose of optimizing treatment strategies.Methods From June 2007 to July 2017,a total of 557 patients were treated with microsurgery via a suboccipital retrosigmoid(RS)approach with neuroelectrophysiology monitoring applied throughout the surgery.Clinical information,preoperative pure tone audiometry,speech discrimination score and auditory brainstem responses,tumor size,duration of surgery,blood loss,rates of facial and cochlear nerve preservation and surgical complications were analyzed using multivariate logistic regression.Correlation between tumor size and surgical duration,blood loss as well as postoperative complications was examined.Results The mean age of al the 557 patients(male=230,37.7%)was45.8±10.8 years.Tumor was larger than 3 cm in diameter in 468 patients(84.0%).Average duration of surgery was 5.2±1.8 h,with a blood loss of 337±145 ml.Total resection was achieved in 513 cases(92.1%)and subtotal resection in 44cases(7.9%).Postopeartive facial nerve function was House-Brackmann gradeⅢor better in 471 patients(84.6%)and gradeⅣor worse in 86 patients(15.4%),with the nerve retaining anatomical integrity in 518 cases(93%).Of the 41 cases with serviceable hearing before surgery,12(29.3%)demonstrated serviceable hearing after surgery.Postoperative complications included CSF leak(n=16,2.9%),trigeminal nerve palsy(n=12,2.2%),diplopia(n=18,3.2%),posterior cranial nerves harassment(n=15,2.7%)and postoperative bleeding(n=5,0.9%).In an adjusted multivariate logistic regression model,tumor size showed a positive correlation with surgical duration,bleeding,postoperative facial palsy and diplopia(P<0.05).Blood loss during surgery significantly increased when the tumor was larger than 5 cm(P<0.05).Conclusion Cranial nerve preservation is the key point in VS surgeries.Meticulous opeartion and continuous electrophysiological monitoring are crucial for improving surgical outcomes.Tumor size can significantly influence surgical duration,bleeding,postoperative facial palsy and diplopia.