后颅窝肿瘤术后患者吞咽困难结局的放射学预测因素
Radiological Predictors for Dysphagia Outcome in Patients Following Posterior Fossa Tumor Surgery.
文献信息
| PMID | 42934993 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Karsten Lachner |
| 作者单位 | Department of Neuroradiology, Goethe University Hospital Frankfurt, Germany. |
| 期刊 | Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale |
| SCI 分区 | Q1 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
重要性： 后颅窝肿瘤（PFT）患者常出现吞咽困难。手术可能导致原有吞咽困难恶化或改善。在此背景下，影像学发现可能有助于预测术后吞咽困难结局。
目的： 通过分析术前脑磁共振成像（pMRI），识别预测术前吞咽困难恶化或改善以及术后新发吞咽困难的放射学预测因素。
地点： 三级转诊医院。
参与者： 接受PFT神经外科治疗的患者。
干预： 术前和术后进行软式内镜吞咽评估。
主要结局指标： 与术后吞咽困难结局相关的pMRI表现（脑神经V、VII、IX、X和XII受累，脑桥腹尾侧受压，橄榄体受压，脑积水）。吞咽困难严重程度根据纤维内镜吞咽困难严重程度量表（FEDSS）评定。
结果： 共纳入43例接受PFT手术的患者（女性60.5%，年龄51.5±15.6岁）。术前吞咽困难发生率从72.1%（n=31）升至79.1%（n=34），中位FEDSS为1（IQR 2，范围1-5）。46.5%（n=20）的病例出现术前吞咽困难恶化，中位数为1（IQR 3，范围1-6），而8例受试者出现新发吞咽困难。23.3%（n=10）的患者术前吞咽困难改善。2例吞咽困难严重程度从重度降至轻度。pMRI与术后吞咽困难结局无显著关联。
结论： 术前脑肿瘤的形态学特征与吞咽困难结局无关。除样本量小限制统计分析外，可以推测仅凭pMRI发现可能不足以预测PFT术后患者的吞咽困难结局。
相关性： 我们的研究提供了关于肿瘤可能与吞咽困难结局相关的特征的见解。未来研究需要更大队列、分析术中因素以及术后MRI发现，以全面理解PFT术后的吞咽困难结局。
英文摘要
IMPORTANCE: Dysphagia is frequently observed in patients with posterior fossa tumor (PFT). Surgery can cause either deterioration of or improvement in preexisting dysphagia. In this context, imaging findings might help in predicting postsurgical dysphagic outcomes.
OBJECTIVE: To identify radiological predictors for worsening or improvement in presurgical dysphagia, and for any new onset of postsurgical dysphagia, by analyzing the presurgical brain magnetic resonance imaging (pMRI).
SETTING: Tertiary referral hospital.
PARTICIPANTS: Patients undergoing neurosurgical treatment for PFT.
INTERVENTION: Flexible endoscopic evaluation of swallowing, before and after surgery.
MAIN OUTCOME MEASURES: pMRI findings (presence of affection of cranial nerves V, VII, IX, X, and XII, ventrocaudal pontine compression, olivary compression, hydrocephalus) associated with postsurgical dysphagia outcomes. Dysphagia severity was rated according to the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS).
RESULTS: Forty-three patients (60.5% female, 51.5 ± 15.6 years) with PFT-surgery were included. Presurgical dysphagia rate increased from 72.1% (n = 31), with a median FEDSS of 1 (IQR 2 range 1-5), to 79.1% (n = 34). In 46.5% (n = 20) of the cases deterioration of presurgical dysphagia was observed with a median of 1 (IQR 3, range 1-6), while 8 subjects showed a new onset of dysphagia. In 23.3% (n = 10) of the patients, an improvement in presurgical dysphagia was observed. In 2 cases, dysphagia severity decreased from severe to mild. pMRI did not show a significant association with postsurgical dysphagic outcome.
CONCLUSIONS: Morphological characteristics of the brain tumor prior to surgery are not associated with dysphagia outcome. Besides the small sample size limiting statistical analysis, one may postulate that pMRI findings alone might not suffice to predict dysphagia outcome in patients after PFT-surgery.
RELEVANCE: Our study provides insights into possible characteristics of the tumor in relation to dysphagia outcome. Future studies warrant a larger cohort, analysis of intraoperative factors, and findings from postsurgical MRI, to fully understand dysphagia outcome after PFT-surgery.