RESUMO
OBJECTIVE: The aim of this study was to compare the clinical characteristics of cystic vestibular schwannomas (CVSs) and solid vestibular schwannomas (SVSs). STUDY DESIGN: Retrospective review. SETTING: Tertiary care center. PATIENTS: A total of 220 patients who underwent microsurgery for vestibular schwannomas between 2007 and 2016. INTERVENTION: CVSs were defined as cystic components ≥1/3 of total tumor volume based on automated volume measurement. Tumors larger than 5âcm were defined as large tumors. MAIN OUTCOME MEASURES: Clinical characteristics and surgical outcomes, including preoperative symptoms, hearing threshold, vestibular function, tumor volume, extent of resection, facial nerve outcomes, and nonfacial complications were evaluated. RESULTS: Tumor volume was significantly larger in CVSs (20.44â±â13.85âcm in CVSs; 4.75â±â6.48âcm in SVSs, pâ<â0.001) and the proportion of larger tumors was also greater in CVSs (66.0% in CVSs; 11.4% in SVSs, pâ<â0.001). Preoperative dizziness was highly prevalent in CVSs (32.1% in CVSs; 18.6% in SVSs, pâ=â0.038) and postoperative facial nerve outcomes were significantly worse in CVSs (67.9% favorable rate in CVSs; 87.4% favorable rate in SVSs, pâ=â0.001). When the comparison was limited to large tumors, no clinical characteristics or surgical outcomes were significantly different. Tumor volume had a greater effect than tumor type on the surgical outcomes. The odds ratios for subtotal resection and unfavorable facial nerve function with a large tumor were 5.77 (confidence interval [CI]: 1.52-21.95, pâ=â0.010) and 5.34 (CI: 1.41-20.22, pâ=â0.014), respectively. CONCLUSION: CVSs tend to be larger than SVSs. Tumor volume, not cystic component, is thought to be a major determinant of surgical outcomes.
Assuntos
Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to validate and compare treatment outcomes for endoscopic resection of sinonasal inverted papilloma (IP) with or without the use of a navigation system. MATERIALS AND METHODS: A total of 58 patients who underwent endoscopic resection of sinonasal inverted papilloma by a single surgeon from 2007 to 2016 at our institution were retrospectively reviewed. Depending on the use of the navigation system, subjects were divided into two groups: a conventional endoscopic resection group without navigation system (CER group) and a navigation-assisted endoscopic resection group (NER group). RESULTS: There were 24 patients (41.4%) in the CER group and 34 patients (58.6%) in the NER group. Treatment outcomes showed that navigation-assisted endoscopic resection was a more beneficial surgical technique than conventional endoscopic resection for sinonasal IP. Post-surgical recurrence was noted in seven cases (29.2%) in the CER group and two cases (5.9%) in the NER group. Accordingly, the recurrence rate was significantly less in the NER group compared to the CER group (p = 0.026). There were two cases of complications (8.3%) in the CER group comprising cerebrospinal fluid leak and periorbital fat exposure, while no complications were noted for the NER group (p = 0.167). CONCLUSION: This study demonstrated that navigation-assisted endoscopic removal of sinonasal IP is helpful for reducing recurrence and avoiding surgical complications. Therefore, navigation systems should be always considered when performing endoscopic removal of sinonasal IP.