METHODS: In this retrospective review, 41 consecutive patients underwent primary resection of FMMs through a far lateral approach. Groups defined based on tumor-neurovascular bundle configuration included Type 1, bundle ventral to tumor; Type 2a-c, bundle superior, inferior, or splayed, respectively; Type 3, bundle dorsal; and Type 4, nerves and/or vertebral artery encased by tumor.
RESULTS: The 41 patients (range 29-81 years old) had maximal tumor diameter averaging 30.1 mm (range 12.7-56 mm). Preoperatively, 17 (41%) patients had cranial nerve (CN) dysfunction, 12 (29%) had motor weakness and/or myelopathy, and 9 (22%) had sensory deficits. Tumor type was relevant to surgical outcomes: specifically, Type 4 demonstrated lower rates of gross total resection (65%) and worse immediate postoperative CN outcomes. Long-term findings showed Types 2, 3, and 4 demonstrated higher rates of permanent cranial neuropathy. Although patients with Type 4 tumors had overall higher ICU and hospital length of stay, there was no difference in tumor configuration and rates of postoperative complications or 30-day readmission.
CONCLUSIONS: The four main types of FMMs in this proposed classification reflected a gradual increase in surgical difficulty and worse outcomes. Further studies are warranted in larger cohorts to confirm its reliability in predicting postoperative outcomes and possibly directing management decisions.
方法:在这篇回顾性综述中,连续41例患者通过远外侧入路进行了FMM的初次切除。根据肿瘤-神经血管束结构定义的组包括1型,束腹至肿瘤;2a-c型,捆绑上级,劣等,或张开,分别为3型,背侧束;和4型,被肿瘤包裹的神经和/或椎动脉。
结果:41例患者(29-81岁)的最大肿瘤直径平均为30.1mm(12.7-56mm)。术前,17例(41%)患者有颅神经(CN)功能障碍,12(29%)有运动无力和/或脊髓病,和9(22%)有感觉缺陷。肿瘤类型与手术结果相关:特别是,类型4显示总切除率较低(65%),术后即刻CN结果较差。长期发现显示2型、3型和4型显示出更高的永久性颅神经病的发生率。尽管4型肿瘤患者的ICU和住院时间总体较高,肿瘤构型和术后并发症发生率及30天再入院率无差异.
结论:在此提出的分类中,四种主要类型的FMM反映了手术难度和预后的逐渐增加。需要在更大的队列中进行进一步的研究,以确认其在预测术后结果和指导管理决策方面的可靠性。