外视镜与显微镜下乙状窦后入路前庭神经鞘瘤手术的比较结果
Comparative Outcomes of Exoscopic Versus Microscopic Retrosigmoid Vestibular Schwannoma Surgery.
文献信息
| PMID | 42757683 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Aleš Vlasák |
| 作者单位 | Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol and Homolka University Hospital, Prague, Czech Republic. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 比较使用手术显微镜与外视镜进行前庭神经鞘瘤（VS）切除术的临床结果。
研究设计： 回顾性单中心队列研究。
地点： 三级转诊颅底中心。
患者： 共有245名成人接受了乙状窦后入路VS切除术：103例显微镜（2017-2020年）和142例外视镜（2021-2024年）；排除标准：NF2、翻修手术和经迷路入路。
干预措施： 采用相同的手术技术和术中神经监测进行显微镜辅助或外视镜辅助乙状窦后入路VS切除术。
主要结局指标： 手术时间；肿瘤体积；切除范围；面神经连续性和功能（出院时及≥1年随访时的House-Brackmann分级）；耳蜗神经连续性和听力保留；脑脊液漏和翻修手术率。
结果： 两组手术时间相当（中位数：6.5 vs. 7.0小时；P=0.37）。在多变量分析中，Koos分级是手术时间的唯一显著预测因素。耳蜗神经保留率（38.3% vs. 36.3%）、出院时HB I-II级（63.4% vs. 64.1%）、面神经术中中断（4.2% vs. 8.7%）、神经重建（4.9% vs. 8.7%）、脑脊液漏和翻修手术率也相似（所有P>0.05）。在随访中，外视镜组显示出较低的House-Brackmann评分（调整后OR：2.54，95% CI：1.31-4.94；P=0.006）。
结论： 外视镜辅助乙状窦后入路VS切除术实现了与手术显微镜相当的临床结果，且未延长手术时间。因此，采用外视镜提供了人体工程学和教学优势，而不影响患者结局。
英文摘要
OBJECTIVE: To compare clinical outcomes of vestibular schwannoma (VS) resection with the operating microscope versus an exoscope.
STUDY DESIGN: Retrospective single-center cohort study.
SETTING: Tertiary referral skull base center.
PATIENTS: A total of 245 adults underwent retrosigmoid VS resection: 103 microscope (2017-2020) and 142 exoscope (2021-2024); exclusions: NF2, revision surgery, and translabyrinthine approaches.
INTERVENTIONS: Microscope-assisted or exoscope-assisted retrosigmoid VS resection using identical surgical technique and intraoperative neuromonitoring.
MAIN OUTCOME MEASURES: Operative time; tumor volume; extent of resection; facial nerve continuity and function (House-Brackmann grade at discharge and ≥1-year follow-up); cochlear nerve continuity and hearing preservation; CSF leak and revision surgery rates.
RESULTS: Operative duration was comparable between groups (median: 6.5 vs. 7.0 h; P=0.37). On multivariate analysis, Koos grade was the only significant predictor of duration. Cochlear nerve preservation (38.3% vs. 36.3%), HB I-II at discharge (63.4% vs. 64.1%), facial nerve intraoperative interruption (4.2% vs. 8.7%), nerve reconstruction (4.9% vs. 8.7%), CSF leak, and revision surgery rates were also similar (all P>0.05). At follow-up, the exoscope group showed lower House-Brackmann scores (adjusted OR: 2.54, 95% CI: 1.31-4.94; P=0.006).
CONCLUSIONS: Exoscope-assisted retrosigmoid VS resection achieves comparable clinical outcomes to the operating microscope without prolonging operative times. Exoscope adoption, therefore, provides ergonomic and educational advantages without compromising patient outcomes.