三模态可视化改善前庭神经鞘瘤手术中的出血控制和面神经结局：一项回顾性对照研究。
Tri-modality visualization improves blood loss control and facial nerve outcomes in vestibular schwannoma surgery: a retrospective controlled study.
文献信息
| PMID | 42880710 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yafeng Wang |
| 作者单位 | Department of Neurosurgery, The Second Hospital of Hebei Medical University, Hebei,China. |
| 期刊 | World neurosurgery |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 本研究旨在通过比较大型前庭神经鞘瘤的临床结局（包括肿瘤切除率、手术时间、术中出血量、神经功能保留和围手术期并发症），评估三镜协同技术相较于传统显微手术的可行性和潜在优势。
方法： 这项回顾性对照队列研究连续纳入64例大型（Koos III-IV级）前庭神经鞘瘤患者。尽管非随机，但患者根据手术技术引入的时间顺序被依次分配至传统单纯显微镜组（n = 45）或新型三镜组（n = 19；整合3D外视镜、神经内镜和手术显微镜）。因此，治疗时期和可视化策略存在固有联系。为尽量减少学习曲线偏倚，所有手术均由经验丰富的颅底手术团队（每位外科医生完成>200例前庭神经鞘瘤手术，处于技术平台期）实施。评估的主要结局包括手术时间、术中出血量、肿瘤切除范围、术后面和听神经功能以及围手术期并发症发生率。
结果： 两组在肿瘤全切除（GTR）率（95% vs. 82%，P = 0.260）或手术时长方面未观察到显著差异。然而，三镜组术中估计出血量显著更低（195± 52 mL vs. 349 ±108 mL，P < 0.001）。此外，三镜组在6个月时面神经功能良好（House-Brackmann I-II级）的比例显著更高（84% vs. 40%，P = 0.002）。听力保留和总体并发症发生率相当。
结论： 与单纯显微镜相比，三镜联合是治疗大型（Koos III-IV级）前庭神经鞘瘤的一种可行策略。它与术中出血量减少相关，并显示出短期和中期面神经恢复改善，且不延长手术时间。然而，目前数据不足以得出围手术期并发症明确减少的结论。通过整合互补的可视化优势，该方法可能有助于减少隐蔽区域，代表了一种以功能保留为导向的显微手术的多模态策略。
英文摘要
BACKGROUND: This study aims to evaluate the feasibility and potential advantages of a triple-scope cooperative technique versus conventional microscopic surgery for large vestibular schwannomas by comparing their clinical outcomes including tumor resection rate, operative time, intraoperative blood loss, neurological function preservation, and perioperative complications.
METHODS: This retrospective controlled cohort study enrolled 64 consecutive patients with large (Koos grade III-IV) vestibular schwannomas. Although non-randomized, patients were sequentially allocated, based on the chronological introduction of the surgical techniques, to either the conventional microscope-alone group (n = 45) or the novel triple-scope group (n = 19; integrating a 3D exoscope, neuroendoscope, and operative microscope). Therefore, the treatment period and the visualization strategy were inherently linked.To minimize learning curve bias, all operations were performed by a highly experienced skull base surgical team (surgeons with >200 VS surgeries each, at a technical plateau).The primary outcomes evaluated included operative time, intraoperative blood loss, extent of tumor resection, postoperative facial and acoustic nerve function, and perioperative complication rates.
RESULTS: No significant differences were observed between the two groups regarding gross total resection (GTR) rates (95% vs. 82%, P = 0.260) or operative duration. However, the triple-scope group demonstrated significantly lower intraoperative estimated blood loss (195± 52 mL vs. 349 ±108 mL, P < 0.001). Furthermore, the rate of favorable facial nerve function (House-Brackmann Grade I-II) at 6 months was significantly higher in the triple-scope group (84% vs. 40%, P = 0.002). Hearing preservation and overall complication rates remained comparable.
CONCLUSION: Compared with microscopy alone, the triple-scope combination is a feasible strategy for large (Koos grade III-IV) vestibular schwannomas. It is associated with reduced intraoperative blood loss and shows improved short- and mid-term facial nerve recovery without prolonging operative time. However, the present data do not provide sufficient evidence to conclude a definitive reduction in perioperative complications. By integrating complementary visualization strengths, this approach may help reduce concealed areas, representing a multimodal strategy for functional preservation-oriented microsurgery.