伽玛刀治疗无效的听神经瘤手术治疗分析

Analysis of surgical treatment of acoustic neuromas after failed gamma knife treatment

目的探讨伽玛刀治疗无效的听神经瘤的手术效果。方法回顾性分析2010年1月至2021年12月首都医科大学三博脑科医院神经外科收治的23例听神经瘤患者(试验组)的临床资料。23例患者既往均接受伽玛刀治疗,此次因肿瘤进展接受手术切除治疗。术中采取听神经瘤功能性保留神经切除的方法。纳入性别构成比,年龄,肿瘤大小、质地及部位匹配,且既往未行伽玛刀治疗的23例患者为对照组。术后予临床随访,采用House-Brackmann(HB)分级评估患者的面神经功能情况。通过影像学随访评估肿瘤有无复发或进展。比较两组患者的基线资料、手术切除程度、术后并发症、面神经功能预后和复发情况。结果试验组面神经与肿瘤的粘连程度较对照组更为严重(P<0.001),试验组的肿瘤全切除率(21.7%,5/23)低于对照组患者(73.9%,17/23)(χ^(2)=12.54,P<0.001);两组的面神经解剖学保留率均为100%(23/23)。试验组术后即刻HB分级Ⅰ~Ⅱ者占73.9%(17/23),与对照组(91.3%,21/23)的差异无统计学意义(P=0.189)。试验组和对照组的中位随访时间分别为57个月(12~133个月)和52个月(14~120个月),两组均无肿瘤复发或进展。至末次随访,试验组和对照组HB分级Ⅰ~Ⅱ级者分别占82.6%(19/23)和95.7%(22/23),两组的差异无统计学意义(P=0.412)。结论伽玛刀治疗无效的听神经瘤的手术切除程度相对较低,通过采取功能性保留神经切除的方法可优化面神经功能结果,且不增加肿瘤的复发风险。

Objective To investigate the efficacy of surgical therapy of acoustic neuromas after failed gamma knife treatment.Methods The clinical data of 23 patients with acoustic neuromas treated in the Department of Neurosurgery,Sanbo Brain Hospital of Capital Medical University from January 2010 to December 2021 were retrospectively analyzed.Twenty-three patients who were previously treated with gamma knife(experimental group)underwent surgical resection because of tumor progression.Functional nerve preservation was performed during the operation.Another 23 patients who had not been treated with gamma knife were defined as the control group with matching sex composition ratio,age,tumor size,texture and location.The patients were clinically followed up and the facial nerve function was evaluated by House-Brackmann(HB)grading system.The recurrence or progression of the tumor was evaluated by imaging follow-up.The baseline data,degree of surgical resection,postoperative complications,outcome of facial nerve function and recurrence were compared between the two groups.Results The degree of adhesion between facial nerve and tumor in the experimental group was greater than that in the control group(P<0.001).The total tumor resection rate in the experimental group(21.7%,5/23)was lower than that in the control group(73.9%,17/23)(χ^(2)=12.54,P<0.001).The anatomic preservation rate of facial nerve was 100%(23/23)in both groups.Postoperative HB gradeⅠ-Ⅱin the experimental group accounted for 73.9%(17/23),which was not significantly different from that in the control group(91.3%,21/23)(P=0.189).The median follow-up time was 57 months(range:12-133 months)in the experimental group and 52 months(range:14-120 months)in the control group.There was no tumor recurrence or progression in the two groups.At the last follow-up,the patients with HB gradeⅠ-Ⅱin the experimental group and control group accounted for 82.6%(19/23)and 95.7%(22/23)respectively,and there was no significant difference between the two groups(P=0.412).Conclusions The degree of surgical resection of advanced acoustic neuromas after failed gamma knife treatment is relatively low.Functional nerve preservation resection can optimize the results of facial nerve function and doesn′t increase the risk of tumor recurrence.