Nguyen Thanh Bac1, Dong Van He2, Vu Van Hoe1, Hoang Kim Tuan1

Tóm tắt

Objectives: To evaluate the results of microsurgery for acoustic neuroma using an intraoperative nerve monitoring system. Subjects and methods: Cross-sectional, retrospective, and prospective description of 74 patients with acoustic neuroma who were microsurgically treated in Viet Duc University Hospital from October 2016 to March 2018. Results: Women (58.11%) were more predominant than men (41.89%). The age mean was 50.41% ± 9.43 years. There was no significant difference between the tumor location on the right and left side (54.41 compared to 45.59%). There were 40 patients with large tumors (54.05%), giant tumors in 20 patients (27.02%), and 14 patients (18.92%) with small tumors < 2.5cm. Postoperative magnetic resonance examinations were indicated for 100% of patients, in which 78.37% full of tumors were taken out and 21.63% were taken almost tumors. The rate of intact facial nerve was 93.3%. The damage rate of the facial nerve was about 20.28%. The most complications were cerebral edema, bleeding, hydrocephalus, death and meningitis (5.4%; 4.05%; 4.05%; 2.7%, and 1.35%, respectively). The recovery of  the function of the VII nerve, grade I, II according to House-Brackmann was 79.72%. Conclusion: Neurosurgical intervention remains the main step in the effective management of vestibular schwannomas. Using a continuous monitoring system for the facial nerve in surgery for vestibular schwannoma has reduced the rate of post-operative facial nerve paralysis.

Từ khóa

#U dây thần kinh số VIII #Theo dõi thần kinh liên tục trong mổ

Tài liệu tham khảo

Amano M., Kohno M., Nagata O., et al. (2011) Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery. Acta Neurochir (Wien); 153(5):1059-1067; discussion 1067. Myrseth E., Møller P., Pedersen P. H., et al. (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery; 56(5):927-35; discussion 927-935. Jackler R. K., Whinney D. (2001) A century of eighth nerve surgery. Otol Neurotol; 22(3):401-416. Arriaga Moisés A., Chen Douglas A. (2001) Facial Function in Hearing Preservation Acoustic Neuroma Surgery. Archives of Otolaryngology–Head & Neck Surgery; 127(5):543-546. Berges C., Fraysse B., Yardeni E., et al. (1993) Intraoperative facial nerve monitoring in posterior fossa surgery: prognostic value. Skull Base Surg; 3(4):214-216. Battista R. A., Wiet R. J., Paauwe L. (2000) Evaluation of three intraoperative auditory monitoring techniques in acoustic neuroma surgery. Am J Otol; 21(2):244-248. Colletti V., Fiorino F. G., Carner M., et al. (2000) Intraoperative monitoring for hearing preservation and restoration in acoustic neuroma surgery. Skull Base Surg; 10(4):187-195. De Seta E., Bertoli G., De Seta D., et al. (2010) New development in intraoperative video monitoring of facial nerve: A pilot study. Otol Neurotol; 31(9): 1498-1502. Minahan R. E., Mandir A. S. (2011) Neurophysiologic intraoperative monitoring of trigeminal and facial nerves. J Clin Neurophysiol; 28(6):551-565. Brackmann D. E., Owens R. M., Friedman R. A., et al. (2000) Prognostic factors for hearing preservation in vestibular schwannoma surgery. Am J Otol, 21(3): 417-24. Cerullo L. J., Grutsch J. F., Heiferman K., et al. (1993) The preservation of hearing and facial nerve function in a consecutive series of unilateral vestibular nerve schwannoma surgical patients (acoustic neuroma). Surg Neurol, 39(6): 485-93. Ciric I., Zhao J. C., Rosenblatt S., et al. (2005) Suboccipital retrosigmoid approach for removal of vestibular schwannomas: facial nerve function and hearing preservation. Neurosurgery, 56(3): 560-570; discussion 560-570.