To characterize clinical features of AN schwannomas and predictors of surgical outcomes.
PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes.
A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040).
AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
目的:为了表征神经鞘瘤的临床特征和手术结果的预测因素方法和材料:对神经鞘瘤的文献进行PRISMA指导的系统综述。随后,我们进行了单因素和多因素回归分析,以确定影响术后结局的变量的预测值.
结果:共评估了42项包含55名患者的研究。演示时的平均年龄为43.9±14.6岁。最常见的症状是CNVI麻痹(69.1%)。海绵窦(49.1%)和脑前池(36.3%)是最常见的受累部位。在中位随访时间为28.4±25.8个月时,手术后完全恢复为36.3%。术前神经麻痹(P<0.001),枕下入路(P=0.007)和肿瘤次全切除术(P=0.044)是术后并发症的重要保护因素。前桥位置和术后并发症是AN恢复的不良预后指标(分别为OR0.10,P=0.030,OR0.10,P=0.028)。次全切除与较高的AN恢复几率显着相关(OR,6.06,P=0.040)。
结论:神经鞘瘤是罕见但严重的肿瘤,可引起显著的发病率,只有大约三分之一的患者在手术后显示完全康复。枕下入路是术后并发症的保护因素,尤其是与次全切除结合时。了解这些因素以及肿瘤特征有助于优化手术计划和术前咨询。