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首页> 外文期刊>Journal of neurosurgery. >Retrosigmoid removal of small acoustic neuroma: Curative tumor removal with preservation of function: Clinical article
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Retrosigmoid removal of small acoustic neuroma: Curative tumor removal with preservation of function: Clinical article

机译：乙状结肠后小神经瘤的切除：保留功能的治愈性肿瘤：临床文章

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Object. Management of small acoustic neuromas (ANs) consists of 3 options: observation with imaging followup, radiosurgery, and/or tumor removal. The authors report the long-term outcomes and preservation of function after retrosigmoid tumor removal in 44 patients and clarify the management paradigm for small ANs. Methods. A total of 44 consecutively enrolled patients with small ANs and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial function by use of intraoperative auditory monitoring of auditory brainstem responses (ABRs) and cochlear nerve compound action potentials (CNAPs). All patients were younger than 70 years of age, had a small AN (purely intracanalicular/cerebellopontine angle tumor ≤ 15 mm), and had serviceable hearing preoperatively. According to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, preoperative hearing levels of the 44 patients were as follows: Class A, 19 patients; Class B, 17; and Class C, 8. The surgical technique for curative tumor removal with preservation of hearing and facial function included sharp dissection and debulking of the tumor, reconstruction of the internal auditory canal, and wide removal of internal auditory canal dura. Results. For all patients, tumors were totally removed without incidence of facial palsy, death, or other complications. Total tumor removal was confirmed by the first postoperative Gd-enhanced MRI performed 12 months after surgery. Postoperative hearing levels were Class A, 5 patients; Class B, 21; Class C, 11; and Class D, 7. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were preserved for 84% and 72% of patients, respectively. Better preoperative hearing resulted in higher rates of postoperative hearing preservation (p = 0.01); preservation rates were 95% among patients with preoperative Class A hearing, 88% among Class B, and 50% among Class C. Reliable monitoring was more frequently provided by CNAPs than by ABRs (66% vs 32%, p < 0.01), and consistently reliable auditory monitoring was significantly associated with better rates of preservation of useful hearing. Long-term follow-up by MRI with Gd administration (81 ± 43 months [range 5-181 months]; median 7 years) showed no tumor recurrence, and although the preserved hearing declined minimally over the long-term postoperative follow-up period (from 39 ± 15 dB to 45 ± 11 dB in 5.1 ± 3.1 years), 80% of useful hearing and 100% of serviceable hearing remained at the same level. Conclusions. As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, the authors suggest that tumor removal should be the first-line management strategy for younger patients with small ANs and preserved hearing.
机译：目的。小声神经瘤（AN）的管理包括3种选择：影像随访观察，放射外科手术和/或肿瘤切除术。作者报告了44例乙状结肠窦切除术后的长期预后和功能保留，并阐明了小型AN的治疗范例。方法。共有44例连续入选的小AN并保留听力的患者接受了乙状结肠后切除术，试图通过对术中听觉脑干反应（ABR）和耳蜗神经复合动作电位（CNAP）进行术中听觉监测来保持听力和面部功能。所有患者均小于70岁，患有小AN（纯粹为小管内/桥小脑角肿瘤≤15 mm），术前可进行听力检查。根据美国耳鼻咽喉科学-头颈外科基金会的听力和平衡委员会的指导方针，这44例患者的术前听力水平如下：A类19例; A类19例; A类19例。 B级，17;以及C级，第8类。具有保留听力和面部功能的根治性肿瘤切除手术技术包括：肿瘤的清晰解剖和减瘤，内耳道的重建以及内耳硬脑膜的广泛切除。结果。对于所有患者，肿瘤均被完全清除，没有发生面瘫，死亡或其他并发症的发生。术后12个月进行的首次术后Gd增强MRI证实了肿瘤的全部清除。术后听力水平为A级，5例; B级，21; C级，11;以及D级，分别为84％和72％的患者术后可听（A级，B级或C级）和有用级（A级或B级）听力。更好的术前听力可提高术后听力保存率（p = 0.01）;术前A级听力患者的保留率为95％，B级患者为88％，C级患者为50％。与ABR相比，CNAP更能提供可靠的监测（66％vs 32％，p <0.01），并且始终如一的可靠听觉监测与更好地保存有用听力密切相关。给予Gd的MRI长期随访（81±43个月[范围5-181个月];中位7年）未见肿瘤复发，尽管长期术后随访期间听力恢复程度最低。 （从5.1±3.1年的39±15 dB到45±11 dB），80％的有用听力和100％的可用听力保持相同水平。结论。由于外科手术技术涉及尖锐的夹层和内耳道的重建以及术中的听觉监测，因此，乙状结肠的小AN切除可以成功治愈根治性肿瘤，而无需长期复发，并且具有出色的功能预后。因此，作者建议对于年轻的AN小和听力稳定的年轻患者，一线治疗策略应为肿瘤切除。

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