Article record

大型前庭神经鞘瘤次全切除术的长期结局：来自听神经瘤次全切除术研究的结果，第一部分——面神经结局与切除程度

Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study, Part I-Facial Nerve Outcomes and Degree of Resection.

临床研究耳科IF 4.2Q1

文献信息

PMID	42714161
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 17 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.；Departments 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, Kaiser Permanente, Bakersfield, California, 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： 完全切除大型前庭神经鞘瘤（VS）会带来显著的面神经[第VII颅神经（CNVII）]麻痹风险。然而，非全切除可能与再生风险增加相关，而再生可能需要进一步治疗并带来额外风险。本研究的目的是评估接受大型VS切除术的患者中，术后CNVII功能与切除范围的长期结局。
方法： 一项多中心、前瞻性、非随机队列研究，纳入接受全切除（GTR）、近全切除（NTR）或次全切除（STR）的大型VS（≥2.5 cm）患者。GTR定义为无可见残留，NTR定义为术后MRI上残留<0.5 cm3，STR定义为任何更大的残留。CNVII功能采用二分类变量评估：House-Brackmann I-II级代表优至良好功能，而House-Brackmann III-VI级代表一般至差功能。
结果： 共纳入126例患者，平均（SD）随访时间为60（±31）个月。术前平均肿瘤直径为3.3 ± 0.7 cm。根据术后MRI，35例接受GTR，39例接受NTR，52例接受STR。较小的术前肿瘤大小（P = .03）和体积（P = .03）与良好的即刻CNVII功能相关。即刻和晚期面神经功能均与切除范围无关。与GTR相比，STR与手术失败率高3倍相关（P = .02），而发生手术失败并需要立体定向放射外科或翻修手术的患者，其长期CNVII功能为一般至差的几率增加（比值比4.6，95% CI，1.7-12.5，P = .002）。
结论： 切除程度不能预测即刻或晚期良好的CNVII功能。手术失败与较差的长期功能相关。在可行时应尝试GTR或NTR，以降低再次手术和面神经不良结局的可能性。

英文摘要

BACKGROUND AND OBJECTIVES: Complete removal of large vestibular schwannomas (VS) poses a significant risk of facial nerve [cranial nerve VII (CNVII)] paralysis. However, less-than-total removal may be associated with an increased risk of regrowth, which could require further treatment with additional risks. The objective was to assess long-term outcomes of postoperative CNVII function in relation to the extent of resection in patients who underwent removal of large VS.
METHODS: A multicenter, prospective, nonrandomized cohort study of patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or subtotal resection (STR). GTR was defined as no visible remnant, NTR as a remnant <0.5 cm3 on postoperative MRI, and STR as any larger remnant. CNVII function was evaluated using binary variables: House-Brackmann grades I-II represented excellent-to-good function, whereas House-Brackmann grades III-VI represented fair-to-poor function.
RESULTS: A total of 126 patients were included with a mean (SD) follow-up of 60 (±31) months. The mean preoperative tumor diameter was 3.3 ± 0.7 cm. Thirty-five received GTR, 39 received NTR, and 52 received STR based on postoperative MRI. Smaller preoperative tumor size (P = .03) and volume (P = .03) were associated with good immediate CNVII function. Neither immediate nor late facial nerve function was related to the extent of resection. STR was associated with a 3-fold higher surgical failure rate compared with GTR (P = .02), and patients who experienced surgical failure requiring stereotactic radiosurgery or revision surgery had increased odds of fair-to-poor long-term CNVII function (odds ratio 4.6, 95% CI, 1.7-12.5, P = .002).
CONCLUSION: The degree of resection did not predict immediate or late good CNVII function. Surgical failure was associated with worse long-term function. GTR or NTR should be attempted whenever feasible to reduce the likelihood of repeat surgery and poor facial nerve outcomes.