[1]刘宁,姚国杰,陈大瑜.脑积水对听神经瘤显微手术治疗效果的影响[J].中国临床神经外科杂志,2022,27(09):758-759.[doi:10.13798/j.issn.1009-153X.2022.09.012]
　LIU Ning,YAO Guo-jie,CHEN Da-yu.Effect of hydrocephalus on microsurgical outcomes of vestibular schwannomas[J].,2022,27(09):758-759.[doi:10.13798/j.issn.1009-153X.2022.09.012]
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脑积水对听神经瘤显微手术治疗效果的影响()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年09期
页码:
758-759
栏目:
论著
出版日期:
2022-09-30

文章信息/Info

Title:
Effect of hydrocephalus on microsurgical outcomes of vestibular schwannomas
文章编号:
1009-153X（2022）09-0758-02
作者:
刘宁; 姚国杰; 陈大瑜
430070 武汉，中国人民解放军中部战区总医院神经外科（刘宁、姚国杰、陈大瑜）
Author(s):
LIU Ning;  YAO Guo-jie;  CHEN Da-yu
Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China
关键词:
听神经瘤; 脑积水; 显微手术; 疗效
Keywords:
Vestibular schwannomas;  Retrosigmoid approach;  Microsurgery;  Hydrocephalus
分类号:
R739.41;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2022.09.012
文献标志码:
A
摘要:
目的 探讨脑积水对听神经瘤显微手术治疗效果的影响。方法 回顾性分析2018~2019年乙状窦后入路手术治疗的41例听神经瘤的临床资料，其中9例合并脑积水。根据肿瘤最大径平均值分为大型听神经瘤（≥34 mm，20例）和小型听神经瘤（<34 mm，21例）。结果 肿瘤全切除30例；次全切除11例。术后继发颅内出血12例、皮下积液4例、脑干或颅神经损伤7例，脑积水加重9例。出院时，预后良好（GOS评分4~5分）36例。术前合并脑积水病人术后继发出血发生率（77.7%，7/9）明显高于术前无脑积水病人（15.6%，5/32；P<0.05），而两者预后良好率无统计学差异（88.9% vs. 87.5%；P>0.05）。大型听神经瘤术后继发出血发生率（60.0%，12/20）明显高于小型听神经瘤（0%；P<0.05）。大型听神经瘤20例中，术前合并脑积水病人术后继发出血发生率（100.0%，7/7）明显高于无脑积水病人（38.5%，5/13；P<0.05）。结论 脑积水不是听神经瘤预后的决定性影响因素，但脑积水与术后出血有关，因此，术中应制定相应的策略以减少术后出血。
Abstract:
Objective To investigate the effect of hydrocephalus on surgical outcomes of patients with vestibular schwannoma (VS). Methods The clinical data of 41 patients with VS who underwent microsurgery through retrosigmoid approach from 2018 to 2019 were retrospectively analyzed. Nine patients were complicated with hydrocephalus. The tumors were divided into large VSs (≥34 mm, 20 patients) and small VSs (<34 mm, 21 patients) according to the mean maximum diameter of tumors. Results Total tumor resection was achieved in 30 patients, and subtotal in 11. Postoperative inintracranial bleeding occurred in 12 patients, subcutaneous effusion in 4, brain stem or cranial nerve injury in 7, and hydrocephalus aggravation in 9. On discharge, 36 patients had good prognosis (GOS score of 4~5). The incidence of postoperative bleeding in the patients with preoperative hydrocephalus (77.7%, 7/9) was significantly higher than that in the patients without preoperative hydrocephalus (15.6%, 5/32; P<0.05), but there was no significant difference in the good prognosis rate between the two groups (88.9% vs. 87.5%; P>0.05). The incidence of postoperative bleeding in large VSs group (60.0%, 12/20) was significantly higher than that in small VSs group (0%; P<0.05). In 20 patients with large VSs, the incidence of postoperative bleeding in the patients with preoperative hydrocephalus (100.0%, 7/7) was significantly higher than that in the patients without hydrocephalus (38.5%, 5/13; P<0.05). Conclusions Hydrocephalus is not a decisive prognostic factor for the patients with VS, but it is associated with postoperative intracranial bleeding. Therefore, appropriate strategies should be adopted to reduce postoperative bleeding.

参考文献/References:

[1] Gupta VK, Thakker A, Gupta KK. Vestibular schwannoma: what we know and where we are heading [J]. Head Neck Pathol, 2020, 14(4): 1058-1066.
[2] McClelland S 3rd, Kim E, Murphy JD, et al. Operative mortality rates of acoustic neuroma surgery: a national cancer database analysis [J]. Otol Neurotol, 2017, 38(5): 751-753.
[3] Gerganov VM, Pirayesh A, Nouri M, et al. Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome [J]. J Neurosurg, 2011, 114(5): 1209-1215.
[4] Morelli D, Pirotte B, Lubansu A, et al. Persistent hydroce-phalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified [J]? J Neurosurg, 2005, 103 (3 Suppl): 247-252.
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备注/Memo

备注/Memo:
（2022-03-10收稿，2022-06-20修回）
通讯作者：姚国杰，E-mail：yaoguojie@sina.com
更新日期/Last Update: 2022-10-31