神经内镜辅助下显微切除前庭神经鞘瘤(附85例临床分析)

Microresection of vestibular schwannoma assisted by neuroendoscopy(clinical analysis of 85 cases)

目的 探讨神经内镜辅助下显微锁孔手术治疗前庭神经鞘瘤策略,评价其在前庭神经鞘瘤术中的操作可行性及意义。方法 回顾性分析南京大学医学院附属南京鼓楼医院2018年1月—2023年6月收治的85例经手术治疗的前庭神经鞘瘤患者的临床资料,术前核磁共振成像(MRI)增强扫描检查,术中采用枕下乙状窦后锁孔入路切除肿瘤。按照手术方式不同,分为观察组45例和对照组40例,观察组结合神经内镜的观察辅助下磨除内听道并切除内听道内肿瘤,对照组运用单纯显微镜切除肿瘤。对比两组肿瘤切除率、面神经保留率、面瘫情况及并发症情况。结果 两组患者基线资料比较,除年龄和肿瘤大小差异有统计学意义(均P<0.01),其他差异均无统计学意义(P>0.05)。两组对比提示观察组内听道内肿瘤全切率(91.1%)高于对照组(60.0%)(P<0.05);术后随访示观察组肿瘤残留复发率(4.44%)低于对照组(15.0%)(P<0.05);面神经功能及面神经保留率两组并无明显差别(P>0.05),术后并发症如脑脊液漏、小脑挫伤等两组无明显差别。本组无死亡、致残病例。结论 神经内镜辅助显微手术治疗前庭神经鞘瘤疗效确切,安全性高,有利于面神经判断及保留,尤其在内听道内肿瘤全切率上相对全程显微镜下切除有显著优势。

Objective To investigate the strategy of endoscopy-assisted microsurgery for treating vestibular schwannomas and evaluate its feasibility and significance in the surgical management.Methods The clinical data of 85 cases of surgically treated vestibular schwannoma admitted to Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2018 to June 2023 were analyzed retrospectively.Preoperative enhanced magnetic resonance imaging(MRI) scanning was performed,followed by tumor resection using a posterior keyhole approach via the suboccipital sigmoid sinus.According to the different surgical methods,45 cases were divided into the group of internal auditory canal removal and resection of internal auditory canal tumors with the assistance of neuroendoscopy,and 40 cases in the group of simple microscopic resection.Tumor resection rate,facial nerve retention rate,facial paralysis,and complications were observed.Results There were no significant differences in baseline data between the two groups(P> 0.05) except for age and tumor size(both P <0.01).The total resection rate of tumors in the internal auditory canal in the observation group(91.1%) was higher than that in the control group(60.0%)(P <0.05).The postoperative follow-up showed that the recurrence rate of tumor residual in the observation group(4.44%) was lower than that in the control group(15.0%)(P <0.05).There was no significant difference in facial nerve function and facial nerve preservation rate between the two groups(P> 0.05).There was no significant difference in postoperative complications such as cerebrospinal fluid leakage and cerebellar contusion between the two groups.There was no death or disability in this group.Conclusions Neuroendoscopic assisted microsurgery for the treatment of acoustic neuroma has a definite therapeutic effect,high safety,and is beneficial for the assessment and preservation of the facial nerve,especially in terms of the total resection rate of tumors in the internal auditory canal,when compared to full process microscopic resection.