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首页> 外文期刊>Neurosurgery >Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings.
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Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings.

机译：放射神经外科手术后的手术：手术策略和组织学发现。

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OBJECTIVE: To retrospectively review the authors' experience with surgical resections after failed radiosurgery for acoustic neuromas. METHODS: The study group consisted of six patients with acoustic neuromas. The median age was 61 years (range, 18-72 yr). The median marginal radiation dose was 11 Gy (range, 10-12.5 Gy). The median interval between radiosurgery and surgical resection was 28 months (range, 4-74 mo). The operative indications were cerebellar ataxia and symptoms associated with increased intracranial pressure. The median follow-up period was 36 months (range, 11-72 mo) after surgical resection. RESULTS: The tumors were subtotally removed (> or = 80%) in four patients and partially removed (< 80%) in the other two patients. Three patients had intratumoral bleeding. Preexisting facial nerve palsy improved in two patients and deteriorated in one patient, and one patient experienced new facial palsy. No other new neurological deficits emerged after surgery. Histological features were typical of acoustic schwannoma, and some tumors were associated with foamy macrophages, myxoid degeneration, and necrosis attributed to radiation effects. At follow-up, the residual tumor was decreased in five patients and increased in one patient with an expanding intratumoral hematoma. CONCLUSION: Surgical resection after radiosurgery is indicated in the presence of such symptoms as cerebellar ataxia and increased intracranial pressure. It must be carefully considered because of the natural regression of transient tumor swelling over time. Surgical resection should be limited to subtotal removal for functional preservation. In patients with tumor enlargement several years after radiosurgery, the possibility of chronic intratumoral bleeding resulting from delayed radiation injury must be considered.
机译：目的：回顾性分析作者在听神经瘤放射治疗失败后进行手术切除的经验。方法：研究组由6例听神经瘤患者组成。中位年龄为61岁（范围为18-72岁）。中位边缘辐射剂量为11 Gy（范围为10-12.5 Gy）。放射手术和手术切除之间的中位间隔为28个月（范围：4-74 mo）。手术适应症为小脑共济失调和颅内压增高相关症状。手术切除后的中位随访期为36个月（11-72个月）。结果：在四名患者中肿瘤被全部切除（>或= 80％），在另两名患者中被部分切除（<80％）。三例患者发生肿瘤内出血。已有的面神经麻痹在2例患者中得到改善，在1例患者中恶化，并且1例患者出现了新的面神经麻痹。手术后没有出现其他新的神经功能缺损。组织学特征是听觉神经鞘瘤的典型特征，一些肿瘤与泡沫巨噬细胞，粘液样变性和由于辐射作用引起的坏死有关。随访时，残留肿瘤在五名患者中减少，而在一名肿瘤内血肿不断扩大的患者中增加。结论：存在小脑性共济失调和颅内压增高等症状时，应行放射外科手术切除。由于短暂的肿瘤肿胀随时间自然消退，因此必须仔细考虑。手术切除应限于部分切除以保留功能。在放射外科手术后数年肿瘤增大的患者中，必须考虑由于延迟放射损伤而导致慢性肿瘤内出血的可能性。

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