基于听神经瘤膜性结构分类行肿瘤切除术的疗效分析  

Analysis of the efficacy of tumor resection based on the classification of membranous structures of vestibular schwannomas

作　　者：王俊文[1] 胡娜[1] 赵恺[1] 李朝曦[1] 徐钰 肖群根 游超 张华楸 舒凯[1] 雷霆[1] Wang Junwen;Hu Na;Zhao Kai;Li Chaoxi;Xu Yu;Xiao Qungen;You Chao;Zhang Huaqiu;Shu Kai;Lei Ting(Department of Neurosurgery,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2025年第1期12-17,共6页Chinese Journal of Neurosurgery

基　　金：湖北省自然科学基金(2023AFB712)。

摘　　要：目的探讨以前庭神经束膜为界面的听神经瘤膜性结构分类及以此为依据对听神经瘤患者实施个体化手术的临床疗效。方法回顾性收集2015年1月至2019年12月华中科技大学同济医学院附属同济医院神经外科收治的300例听神经瘤患者的临床资料,根据前庭神经束膜的完整性、清晰度及其与面神经的位置关系依次将听神经瘤膜性结构分为a(72例)、b(195例)、c(33例)三类并实施个体化手术切除,分析并比较三类患者临床资料的差异。术后1周行头颅MRI检查评估并比较三类患者的肿瘤切除程度。术后1个月、1年对患者进行临床随访,采用House-Brackmann(H-B)分级评估并比较三类患者术后面神经功能情况,其中H-B分级Ⅰ~Ⅱ级为面神经功能良好;通过美国耳鼻咽喉头颈外科学会听力分级标准评估并比较三类患者术后听力保留情况,其中纯音听阈均值>50 dB、言语分辨率≥50%为有效听力。结果300例患者中,肿瘤全切除262例(87.33%),近全切除29例(9.67%),部分切除9例(3.00%)。术后10例(3.33%)患者发生并发症,其中脑脊液漏5例,脑积水2例,切口感染、小脑出血、远隔部位出血(额叶)各1例。292例(97.33%)患者术中保留了面神经解剖结构,术前78例(26.00%)无有效听力者术后听力均未恢复。术后1个月、1年随访显示,面神经功能良好率分别为87.33%(262/300)、88.67%(266/300);术前存在有效听力的患者中,术后有效听力保留率分别为69.37%(154/222)、70.27%(156/222)。三类患者的年龄、性别、肿瘤侧别的差异均无统计学意义(均P>0.05);肿瘤质地、Koos分级的差异均具有统计学意义(均P<0.05);其中囊性听神经瘤膜性结构的完整性和清晰度较实性差,肿瘤Koos分级3~4级较1~2级膜性结构的完整性和清晰度差,b、c类患者中Koos分级3~4级占比均较a类高,c类较b类高(均P<0.05)。三类患者的肿瘤切除程度、术后1个月及1年的面神经功能和听力的差�Objective To explore the classification of membranous structures of vestibular schwannomas with vestibular nerve bundle membrane as the interface,and to study the clinical efficacy of individualized surgical strategies based on the classification.Methods A retrospective study was conducted to analyze the clinical data of 300 patients with vestibular schwannoma admitted to the Department of Neurosurgery,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from January 2015 to December 2019.According to the integrity,clarity,and positional relationship with the facial nerve of the vestibular nerve bundle membrane,the membranous structures of vestibular schwannoma were classified into three types(type a/b/c:72,195 and 33 cases,respectively),and individualized surgery strategy was applied based on the aforementioned classification.The intergroup differences of clinical characteristics were analyzed.Postoperative facial nerve and hearing function were evaluated by House-Brackmann(H-B)grade and American Academy of Otolaryngology Head and Neck Surgery(AAO-HNS)scale at 1 month and 1 year after surgery by outpatient service or telephone review.H-B gradesⅠtoⅡindicated good facial nerve function;effective hearing function was defined as the average pure tone average(PTA)>50 dB and the speech resolution≥50%.Results Of the 300 patients,total resection was performed in 262 patients(87.33%),near total resection in 29 cases(9.67%)and subtotal resection in 9 cases(3.00%).Ten patients(3.33%)suffered from postoperative complications(cerebrospinal fluid leakage in 5 cases,hydrocephalus in 2 cases,incision infection in 1 case,cerebellum hemorrhage in 1 and remote hemorrhage of frontal lobe in 1).At 1-month and 1-year follow-up after surgery,the good facial nerve function ratio were 87.33%(262/300)and 88.67%(266/300)respectively.Among the patients who had effective hearing before surgery,the effective hearing retained ratios after surgery were 69.37%(154/222)and 70.27%(156/222)respec

关 键 词：神经瘤 听 神经外科手术 面神经 耳蜗神经 前庭神经 治疗结果 

分 类 号：R739.4[医药卫生—肿瘤]