Article record

大型前庭神经鞘瘤次全切除术的长期结局：听神经瘤次全切除术研究第三部分——围手术期指标与并发症的结果

Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part III Perioperative Measures and Complications.

临床研究耳科IF 4.2Q1

文献信息

PMID	42714146
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Ashkan Monfared 查看其他 21 位作者 Richard K Gurgel；Philip V Theodosopoulos；Thomas L Haupt；Ronald E Warnick；Parisa Sabetrasekh；Carleton Eduardo Corrales；Yona Vaisbuch；Nikolas H Blevins；John S Oghalai；Alex D Sweeney；Marlan R Hansen；Bruce J Gantz；Rick F Nelson；Joe Walter Kutz；Brandon Isaacson；Moises A Arriaga；Sam Maghami；Richard L Amdur；Huan Zhang；Samuel H Selesnick；Robert K Jackler
作者单位	Department of Otolaryngology, George Washington University, Washington, District of Columbia, USA. 查看其他 16 条单位信息 Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.；Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.；Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA.；Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA.；Department of Otolaryngology-Head and Neck Surgery, Massachusetts Ear and Eye Infirmary, Boston, Massachusetts, USA.；Department of Otolaryngology, Rambam Medical Center, Haifa, Israel.；Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA.；Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA.；Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern, Dallas, Texas, USA.；Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical School, New Orleans, Louisiana, USA.；Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA.；Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA.
期刊	Neurosurgery
SCI 分区	Q1
IF	4.2
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景与目的： 大型前庭神经鞘瘤（VS）的治疗越来越多地包括部分切除策略，但切除范围对围手术期和长期症状结局的影响仍不清楚。本研究评估切除范围如何影响围手术期指标、并发症和平衡功能。
方法： 2004年至2019年开展了一项前瞻性、多中心队列研究。共纳入126例肿瘤至少2.5 cm的VS患者。围手术期结局包括手术时长、住院时间和并发症，如脑脊液漏、伤口感染和脑膜炎。长期结局包括头痛严重程度、头晕障碍量表评分和标准化平衡测试。分析中考虑了人口学变量、肿瘤特征和手术入路。
结果： 患者平均年龄为48 ± 14岁，桥小脑角肿瘤平均直径为3.3 ± 0.7 cm。根据术后MRI，35例患者接受全切除术，39例接受近全切除术，52例接受次全切除术（STR）。手术时长、住院时间和总体并发症发生率不因切除范围而异。较年轻年龄与脑脊液漏相关（P = .024），经迷路入路后脑膜炎更常见（P = .03）。1年时，接受全切除术或近全切除术的患者头痛严重程度显著改善（P = .015和P = .012），而STR患者则没有。残余肿瘤体积与1年时头晕障碍量表评分呈显著正相关（r = 0.55，P = .03）。STR还与较差的术后平衡功能相关。
结论： 在大型VS手术中，切除范围不影响围手术期指标或早期并发症发生率。然而，次全切除术与1年时持续性头痛、更严重的头晕障碍和更差的平衡结局相关。这些发现表明，与更完全的切除相比，部分切除并未带来围手术期获益，并可能损害长期症状恢复。

英文摘要

BACKGROUND AND OBJECTIVES: Management of large vestibular schwannomas (VS) increasingly includes partial resection strategies, yet the impact of extent of resection on perioperative and long-term symptom outcomes remains unclear. This study evaluates how the extent of resection influences perioperative measures, complications, and balance performance.
METHODS: A prospective, multicenter cohort study was conducted from 2004 to 2019. A total of 126 patients with VS measuring at least 2.5 cm were enrolled. Perioperative outcomes included operation duration, length of stay, and complications such as cerebrospinal fluid leak, wound infection, and meningitis. Long-term outcomes included headache severity, Dizziness Handicap Inventory scores, and standardized balance testing. Analyses accounted for demographic variables, tumor characteristics, and surgical approach.
RESULTS: The mean patient age was 48 ± 14 years, and the mean cerebellopontine angle tumor diameter was 3.3 ± 0.7 cm. Based on postoperative MRI, 35 patients underwent gross total resection, 39 underwent near-total resection, and 52 underwent subtotal resection (STR). Operation duration, length of stay, and overall complication rates did not differ by extent of resection. Younger age was associated with cerebrospinal fluid leak (P = .024), and meningitis was more frequent after translabyrinthine approach (P = .03). At 1 year, patients who underwent gross total resection or near-total resection exhibited significant improvement in headache severity (P = .015 and P = .012), whereas STR patients did not. Residual tumor volume showed a significant positive association with Dizziness Handicap Inventory score at 1 year (r = 0.55, P = .03). STR was also associated with poorer postoperative balance performance.
CONCLUSION: The extent of resection did not influence perioperative measures or early complication rates in large VS surgery. However, subtotal resection was associated with persistent headaches, greater dizziness handicap, and worse balance outcomes at 1 year. These findings indicate that partial resection does not confer perioperative benefit and may compromise long-term symptom recovery compared with more complete resection.