UNASSIGNED:我们旨在探讨神经下切除技术在前庭神经鞘瘤(VSs)手术中分离和切除神经鞘膜下肿瘤的应用和前景。
UNASSIGNED:这项研究回顾性分析了2015年7月至2020年10月在神经外科接受乙状窦后入路手术的124例VSs患者,唐都医院,空军军医大学.将就以下方面讨论数据:临床特征,手术策略,肿瘤切除范围,面部声学功能保护,术后并发症。
UNASSIGNED:104例患者实现了肿瘤的大体全切除(GTR),GTR率为83.9%,20例患者获得肿瘤次全切除(STR)。GTR和STR在面神经和听神经功能保留方面无显著差异,以及在实体和囊性肿瘤之间的肿瘤切除。在完全解剖保留面神经方面,保留率达到97.6%。使用House-Brackmann(HB)分级评分评估面神经功能。因此,HB等级为I-II,III-IV,和V-VI测定为96(77.4%),25(20.2%),和3例(2.4%),分别,术后1周,占110例(88.7%),13例(10.5%),1例(0.8%),分别,在6个月。手术前听力可用的35例患者中,有15例(42.9%)在术后6个月仍具有听力可用。术后小脑或脑干出血5例,一名患者死亡。多因素logistic回归分析显示年龄较大(≥60岁,p=0.011),大肿瘤(>3厘米,p=0.004),囊性肿瘤(p=0.046)是与肿瘤与脑干和面听神经粘连程度相关的独立危险因素。
UNASSIGNED:我们成功地将神经下切除技术应用于一系列VSs患者,并取得了令人满意的结果。准确识别会阴部及神经下切除肿瘤,可有效减少术中面听神经的扰动,为判断肿瘤边界提供直观依据。在VSs的手术治疗中,神经下切除技术可能有助于提高肿瘤的全切除率和面听神经功能的保留。
UNASSIGNED: We aimed to explore the application and prospects of the subperineural resection technique for tumor separation and removal under the perineurium during surgery for vestibular schwannomas (VSs).
UNASSIGNED: This study retrospectively analyzed 124 patients with VSs who underwent surgery via a retrosigmoid approach from July 2015 to October 2020 in the Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University. The data will be discussed with regard to the following aspects: clinical features, surgical strategies, tumor resection extent, facial-acoustic function preservation, and postoperative complications.
UNASSIGNED: Gross total resection (GTR) of the tumor was achieved in 104 patients, with a GTR rate of 83.9%, and subtotal resection (STR) of the tumor was achieved in 20 patients. There was no significant difference in facial and acoustic nerve functional preservation between GTR and STR, as well as in tumor resection between solid and cystic tumors. The retention rate reached 97.6% in terms of complete anatomical facial nerve preservation. Facial nerve function was assessed using the House-Brackmann (HB) grading score. Consequently, HB grades of I-II, III-IV, and V-VI were determined for 96 (77.4%), 25 (20.2%), and 3 (2.4%) cases, respectively, 1 week postoperatively and accounted for 110 cases (88.7%), 13 cases (10.5%), and 1 case (0.8%), respectively, at 6 months. Fifteen of 35 (42.9%) patients with serviceable hearing before the operation still had serviceable hearing at 6 months postoperatively. There were 5 cases of cerebellar or brainstem bleeding after the operation, and one patient died. Multivariate logistic regression analysis showed that older age (≥60 years, p = 0.011), large tumor (>3 cm, p = 0.004), and cystic tumor (p = 0.046) were independent risk factors associated with the extent of adhesion between the tumor and the brainstem and facial-acoustic nerve.
UNASSIGNED: We successfully applied the subperineural resection technique to a large series of patients with VSs and achieved satisfactory results. Accurate identification of the perineurium and subperineural resection of the tumor can effectively reduce the disturbance of the facial-acoustic nerve during the operation and provide an intuitive basis for judging the tumor boundary. The subperineural resection technique may be conducive to improving the rate of total tumor resection and facial-acoustic nerve functional preservation in the surgical treatment of VSs.