Hypervascularized Large Vestibular Schwannomas: Single-Center Experience in a Series of Forty Cases.

Autor:	Mastronardi L; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Campione A; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Boccacci F; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Scavo CG; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Carpineta E; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Cacciotti G; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Roperto R; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Stati G; Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy., Liu JK; Department of Neurological Surgery, Rutgers University-New Jersey Medical School, Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston and Newark, New Jersey, USA.
Jazyk:	angličtina
Zdroj:	World neurosurgery: X [World Neurosurg X] 2022 Oct 04; Vol. 17, pp. 100142. Date of Electronic Publication: 2022 Oct 04 (Print Publication: 2023).
DOI:	10.1016/j.wnsx.2022.100142
Abstrakt:	Background: Vestibular schwannomas (VS) are usually hypovascularized benign tumors. Large VS (Koos grade IV) with unusual vascular architecture are defined as hypervascular (HVVS); the excessive bleeding during microsurgery has a negative impact on results. Methods: Forty consecutive patients were operated on for HVVS (group A). A tendency to bleed and adherence of capsule to nervous structures were evaluated by reviewing intraoperative video records. The cisternal facial nerve (FN) position was reported. Microsurgical removal was classified as total, near-total, subtotal, or partial and the MIB-1 index was evaluated in all. FN results were classified according to the House-Brackmann scale. Results: Results of Group A were compared with those of 45 patients operated on for large low-bleeding VS (group B). Mean tumor diameter was 3.81 cm in group A and 3.58 cm in group B; the mean age was 42.4 and 56.3 years, respectively. The mean American Society of Anesthesiologists Physical Status Scale class of group A was 1.67 versus 2.31 of group B (P < 0.01). Total or near-total resection was accomplished in 76.5% of group A versus 73.3% of group B. Tight capsule adhesion was observed in 67.5% of group A versus 57.8% of group B. Mean MIB-1 was 1.25% and 1.08%, respectively.FN anatomic preservation was possible in 84.6% of group A versus 95.5% of group B; 67.5% of group A had HB grade I or II FN outcome versus 93.3% of group B ( P < 0.001). In group A, 8 patients (20.0%) experienced transient postoperative complications versus 4.4% of group B. Recurrence/regrowth was observed in 4 patients in group A versus 1 in group B. Conclusions: Intraoperative video for classification of HVVS was used. Microsurgery of large HVVS was associated with higher (usually transient) complications and recurrence/regrowth rates and poorer FN outcome, especially in patients with tight capsule adhesion. (© 2022 The Author(s).)
Databáze:	MEDLINE
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