通过吸收文献中的个性化患者数据来评估面部神经鞘瘤的各种管理策略的面神经结果,以解决管理中的争议。
PubMed-国家生物技术信息和Scopus数据库中心。
对有关面部神经鞘瘤的研究文献进行了系统综述。如果研究提供患者水平的数据,干预类型,干预前后House-Brackmann(HB)等级,和肿瘤通过面神经段定位。
从31项研究中收集487名患者的个性化数据。80例(16.4%)面部神经鞘瘤经观察处理,25(5.1%)进行手术减压,20(4.1%)立体定向放射外科,225例(46.2%)全切除,和137(28.1%)的次全切除/剥离手术。剥除手术/次全切除术具有良好的术前面神经功能,在96%的病例中保持HB1级或2级。完全切除硬膜内肿瘤,术前HB分级对面神经预后无显著影响(n=45,P=0.46).然而,术前HB分级较低与颞内肿瘤患者面神经预后较好相关(n=56,P=.009).当进行立体定向放射外科手术时,40%的患者病情好转,35%是稳定的,25%的人面部功能恶化。面神经减压术很少影响短期面神经状况。
这项研究的数据有助于描述哪些治疗策略在哪些临床方案中是最佳的。这些发现可用于为这种复杂的病理学开发更明确的管理算法。
To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management.
PubMed-National Center for Biotechnology Information and Scopus databases.
A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment.
Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status.
The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.