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Abstract：
BACKGROUND: Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign, well-encapsulated, and slow-growing tumor that originates from Schwann cells, which form the myelin sheath around the vestibulocochlear nerve (VIII cranial nerve). The surgical treatment of this condition presents a challenging task for surgeons, as the tumor\'s location and size make it difficult to remove without causing damage to the surrounding structures. In recent years, fluorescein sodium (FS) has been proposed as a tool to enhance surgical outcomes in VS surgery. This essay will provide an analytical comparison of the use of FS in VS surgery, evaluating its benefits and limitations and comparing surgical outcomes with and without FS-assisted surgery.
METHODS: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon\'s opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up.
RESULTS: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests.
CONCLUSIONS: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.
METHODS: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon\'s opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up.
RESULTS: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests.
CONCLUSIONS: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.
摘要：
背景：前庭神经鞘瘤（VS），也被称为听神经瘤，是良性的，封装良好，来自雪旺氏细胞的缓慢生长的肿瘤，在前庭耳蜗神经（VIII脑神经）周围形成髓鞘。这种情况的手术治疗对外科医生来说是一项具有挑战性的任务，因为肿瘤的位置和大小使其难以在不对周围结构造成损害的情况下移除。近年来,荧光素钠（FS）已被提议作为增强VS手术结果的工具。本文将对FS在VS手术中的使用进行分析比较，评估其益处和局限性，并比较有无FS辅助手术的手术结果。
方法：在圣菲利波内里医院进行的一项回顾性研究中，我们检查了在2017年1月至2023年12月期间手术的VS病例.将患者分为两组:A组,其中包括在2020年1月之前未使用FS进行手术的患者（102例），B组,其中包括2020年1月后接受FS手术的患者（55例）。所有手术均采用乙状窦后入路,肿瘤大小是根据库斯分类的，etal.分类系统。使用术中外科医生的意见和术后MRI成像评估手术切除的程度。术前和术后，评估面神经功能和听力。B组,FS用于辅助外科手术，这是使用配备了集成荧光过滤器的外科显微镜进行的。术后6个月和每年进行临床和MRI对照，没有患者失去随访。
结果：本研究调查了VS患者术中荧光素暴露对肿瘤切除和临床结局的影响。该研究发现，术中接受荧光素治疗的患者之间的肿瘤切除率存在统计学上的显着差异（p=0.037）。使用Koos分类系统的进一步分析揭示了荧光素暴露的显着影响，特别是在Koos3亚组(p=0.001)。值得注意的是,两组在听力损失或面神经功能方面无显著差异。Spearman相关分析显示肿瘤大小与Koos呈正相关，年龄,和大小，但是面神经功能检查之间没有发现显着相关性。
结论：FS辅助VS手术可能会增强肿瘤切除，允许更全面的肿瘤切除。
方法：在圣菲利波内里医院进行的一项回顾性研究中，我们检查了在2017年1月至2023年12月期间手术的VS病例.将患者分为两组:A组,其中包括在2020年1月之前未使用FS进行手术的患者（102例），B组,其中包括2020年1月后接受FS手术的患者（55例）。所有手术均采用乙状窦后入路,肿瘤大小是根据库斯分类的，etal.分类系统。使用术中外科医生的意见和术后MRI成像评估手术切除的程度。术前和术后，评估面神经功能和听力。B组,FS用于辅助外科手术，这是使用配备了集成荧光过滤器的外科显微镜进行的。术后6个月和每年进行临床和MRI对照，没有患者失去随访。
结果：本研究调查了VS患者术中荧光素暴露对肿瘤切除和临床结局的影响。该研究发现，术中接受荧光素治疗的患者之间的肿瘤切除率存在统计学上的显着差异（p=0.037）。使用Koos分类系统的进一步分析揭示了荧光素暴露的显着影响，特别是在Koos3亚组(p=0.001)。值得注意的是,两组在听力损失或面神经功能方面无显著差异。Spearman相关分析显示肿瘤大小与Koos呈正相关，年龄,和大小，但是面神经功能检查之间没有发现显着相关性。
结论：FS辅助VS手术可能会增强肿瘤切除，允许更全面的肿瘤切除。
