| Objective:By collecting the preoperative imaging examination of acoustic neuroma and the clinical data of patients,the relationship between the above factors and the degree of tumor resection and the incidence of postoperative complications was determined,and the related risk factors affecting the surgical prognosis of acoustic neuroma were discussed,so as to provide theoretical support for improving the surgical prognosis of patients and improving the quality of life.Methods:Preoperative imaging examinations and clinical data of 126 inpatients undergoing surgery in the First Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University from September 2018 to January 2021 were collected.All patients were evaluated preoperatively for facial paralysis according to House-Backmann facial nerve function grading standard.And perfect head MRI and craniocerebral CT thin scan determine size of acoustic neuroma,brainstem presence of oppression edema,cystic or solid and cystic type image credits,preoperative ecg,chest CT and routine blood and blood biochemical examination related to inspection rule out surgery after surgery contraindications,tumor resection are subject to the same medical team outside of our nerve after sigmoid sinus approach,Postoperative tumor pathology indicated that all of them were acoustic schwannomas.Two hours after the end of surgery,intracranial hematoma was excluded by cranial CT.Postoperative facial paralysis was determined by facial nerve function assessment one week after surgery.The degree of tumor resection was evaluated based on intraoperative observations and cranial MRI examination two weeks after surgery.If unexplained fever is present after surgery,accompanied by headache,vomiting,meningeal irritation signs,blood routine and cerebrospinal fluid test to determine whether it is aseptic meningitis.The dressings were changed actively after operation to observe whether there was cerebrospinal fluid leakage.In this study,the patients’age,gender,preoperative facial paralysis(House-Backmann grade),operative duration,economic expenditure and acoustic neuroma tumor size(Koos grade),cystic solid,cystic imaging classification(external cystic degeneration,intratumoral cystic degeneration and multiple cystic degeneration),brain stem compression and edema,and whether the operation was complete.The postoperative complications(facial paralysis,intracranial hemorrhage,aseptic meningitis,cerebrospinal fluid leakage)that seriously affect the survival and quality of life of the patients were collected,and other complications were ignored to explore the related factors affecting the prognosis of acoustic neuroma surgery.Results:Among all the patients,there were 59 males and 67 females,aged from 13 to 71 years old,with an average age of 46.91±11.29 years old(≈47 years old),among which 73 patients were older than 47 years old and 53 patients were younger than 47 years old.The size of acoustic neuroma according to KOOS classification:0 cases of grade Ⅰ;Grade Ⅱ 12 cases;Grade Ⅲ 27 cases;Grade IV 87 cases.There were 19 cases of brain stem compression edema,107 cases of brain stem compression edema.There were 81 cases of cystic solid acoustic neuroma and 45 cases of solid acoustic neuroma.Cystic classification:Class IA:3 cases;Anterior IB:15 cases;Ⅰb medial group:11 cases;Posterior IB:17 cases;Class IIA:1 case;Class IIB:22 cases;Class IIIA:4 cases;Class ⅢB:8 cases.Preoperative facial paralysis:55 cases,no preoperative facial paralysis:71 cases;Total resection,subtotal resection and nearly total resection:110 cases,partial resection:16 cases.Postoperative complications:21 cases,including 15 cases of facial paralysis,2 cases of intracranial hemorrhage,3 cases of aseptic meningitis,1 case of cerebrospinal fluid leakage,and 105 cases of no postoperative complications.The shortest duration of operation was 2 hours and 50 minutes,and the longest was 8 hours and 40 minutes,with an average duration of about 4 hours and 26 minutes.Among them,109 patients had a longer duration than the average,while 17 patients had a shorter duration than the average.The lowest,highest and average economic expenditure of the patients was 54,000 yuan,217,000 yuan and 86,000 yuan,among which 106 patients had higher economic expenditure than the average,and 20 patients had lower economic expenditure than the average.The statistical results showed that KOOS4 grade tumor,brain stem oppression and edema,preoperative facial paralysis,and cystic solid were related factors(P<0.05),while age and gender were not related factors(P<0.05).Age,brain stem oppression and edema,preoperative facial paralysis,and cystic and solid nature were related factors(P<0.05),while gender and tumor size were not related factors(P<0.05).According to the statistical results,cystic tumor was a risk factor related to the degree of surgical resection and the incidence of postoperative complications.Further analysis showed that cystic imaging classification was also a related factor affecting the degree of surgical resection and the incidence of postoperative complications(P<0.05).Pairwise comparison of cystic classification in this study Extranatumoral cystic lesions with cystic portion located in the anterior and medial side of the tumor,intratumoral cystic lesions with cystic portion greater than 50%,and multiple cystic lesions were related risk factors for the degree of surgical resection of the tumor and the incidence of postoperative complications(P<a).KOOS4 grade,tumor compression brain stem edema,cystic and preoperative facial paralysis were the related risk factors affecting the operative duration and economic expenditure of patients with acoustic neuroma,and advanced age was the related risk factors affecting the economic expenditure of patients(P<0.05).Conclusions:1.Brain stem compression and edema,preoperative facial paralysis,tumor cystic changes and cystic changes are related risk factors affecting the degree of tumor resection and the incidence of postoperative complications in acoustic neuroma surgery;2.Grade KOOS4 tumor is a related risk factor affecting the degree of surgical resection of acoustic neuroma,but has no correlation with the incidence of postoperative complications;3.Old age is a related risk factor for postoperative complications of acoustic neuroma,but not related to the degree of surgical resection;4.Gender is not a risk factor affecting the degree of tumor resection and postoperative complications in acoustic neuroma surgery;... |
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