The Analysis Of Clinical Characteristics Associated With The Degree Of Resection And Postoperative Complications Of Acoustic Neuroma

Objective:We aim to explore the clinical characteristics associated with the extent of resection and postoperative complications of acoustic neuroma,analyze the risk factors correlated to the extent of tumor resection,so as to facilitate the surgical treatment and avoid postoperative complicationsMethods:This study collected the clinical data of 197 patients with acoustic neuroma who underwent surgery in the First Affiliated Hospital of China Medical University from July 2015 to June 2018.The data including general data,clinical manifestations,imaging characteristics,surgical approach,extent of resection and postoperative complications were retrospectively analyzed.Following up those patients for 6 to 42 months,we summarized the clinical characteristics and the occurrence of postoperative complications Evaluating the pre-operational and post-operational KPS score,analyzing the correlation between age,sex,size of tumors,relationship between tumors and blood vessel and facial nerve,brain stem compression and the extent of tumor resection and postoperative complications,so as to clarify clinical characteristics associated with the risk factors of resection degree and postoperative complicationsResults:In those 197 patients,96(48.7%)were males and 101(51.3%)were females,and the average age was 57.7±8.6 years old.All of those patients underwent microsurgery via retrosigmoid approach.All pathological diagnosis were acoustic neuroma,WHO I grade.There were 172 gross total resections,25 subtotal resections or partial resections Postoperative complications occurred in 26 cases,including ipsilateral facial nerve paralysis in 15 cases,ipsilateral facial numbness in 6 cases,obstinate subcutaneous effusion in 2 cases(cured by repeated subcutaneous aspiration and compressive bandaging),intracranial infection in 2 cases(cured after administration of antibiotics),cerebrospinal fluid rhinorrhea in 1 case(cured after postural control).Preoperative symptoms of other patients were improved to varying degrees.There were no clinical deaths.Fourteen out of twenty-five patients who failed to complete resection of tumors underwent radiotherapy.No significant progress of tumors was observed in the follow-up of 25 patients.During the follow-up period,there was no recurrence of tumors.Facial nerve paralysis and facial numbness were improved in varying degrees.Statistical analysis showed that the average KPS score was 89.7±9.1 after operation,which was better than that before operation(P=0.028).The influence of tumor size,vascular encapsulation,facial nerve adhesion and brain stem edema caused by tumor compression on the degree of surgical resection was statistically different(P=0.012,P=0.002,P=0.003,P<0.001).Age,facial nerve adhesion and brain stem edema caused by tumor compression had statistically differential effect on the occurrence of postoperative complications(P=0.002,P=0.019,P<0.001).Conclusion:Surgical resection via retrosigmoid approach under microscope is the best surgical treatment of acoustic neuroma,and radiotherapy plays an important role in the adjuvant treatment of residual tumors.Tumor size,vascular encapsulation,facial nerve adhesion and brain stem edema caused by tumor compression are risk factors associated with the degree of tumor resection.Age,facial nerve adhesion and brain stem edema caused by tumor compression are risk factors of occurrence of complications after surgery.