Optimal Extent of Resection in Vestibular Schwannoma Surgery : Relationship to Recurrence and Facial Nerve Preservation
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概要
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Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p=0.620). However, recurrence was significantly less after NTR than STR (p=0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p=0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p=0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.
- 日本脳神経外科学会の論文
- 2006-04-15
著者
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KIM Dong
Department of Environmental Medical Biology, Wonju College of Medicine, Yonsei University
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JUNG Hee-Won
Department of Neurosurgery, Seoul Natioal University, College of Medicine, Seoul, Korea
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Kim Chi
Department of Neurology, Seoul National University Hospital
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Jung Hee-won
Department Of Eurosurgery College Of Medicine Seoul National University
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Kim Chi
Department Of Dermatology College Of Medicine And Medical Research Institute Chungbuk National Unive
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Kim Dong-wan
Departments Of Internal Medicine Seoul National University Hospital
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Park Chul-kee
Department Of Neurosurgery Seoul National University College Of Medicine Seoul R.o.k.:neuroscience R
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Kim Dong
Department Of Neurosurgery Seoul National University College Of Medicine Seoul R.o.k.:neuroscience R
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Kim Dong
Department Of Anatomy School Of Medicine Kyungpook National University
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Jung Hee-won
Department Of Neurosurgery Seoul National University College Of Medicine Seoul R.o.k.:neuroscience R
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SEOL Ho
Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, R.O.K.
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KIM Choong-hyo
Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, R.O.K.
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CHUNG Young-Seob
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, R.O.K.
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Kim Choong-hyo
Department Of Neurosurgery Kangwon National University College Of Medicine Chuncheon R.o.k.:neurosci
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Seol Ho
Department Of Neurosurgery Kangwon National University College Of Medicine Chuncheon R.o.k.:neurosci
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Chung Young-seob
Department Of Neurosurgery Seoul National University College Of Medicine Seoul R.o.k.:neuroscience R
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Park Chul-kee
Department Of Neurosurgery Seoul National University College Of Medicine Seoul National University
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