Application of multimodal technology in microsurgical resection of acoustic neuromas

Abstract

Objective To investigate the clinical outcome of microsurgical resection of acoustic neuromas via suboccipital retrosigmoid approach with the assistance of multimodal techniques. Methods The clinical data of 204 patients with acoustic neuromas were retrospectively analyzed who were admitted to Neurosurgery Department at the First Affiliated Hospital of Chongqing Medical University from September 2010 to September 2016. A total of 48 patients were treated with the assistance of multimodal techniques (multimodal group), and conventional surgical procedures were performed in 156 patients (conventional group). The extent of tumor resection was scored according to enhanced-MRI imagine at 1 week post surgery, the function of facial nerve was evaluated according to House-Brackmann (H-B) scale at 2 weeks following surgery, and the function of acoustic nerve was assessed based on American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification scale at 2 weeks post surgery. All patients were followed up in outpatient clinic and arranged for radiological (MRI) follow-up in 3 months, 6 months and 1 year after surgery. The function of facial nerve was evaluated 6 months after surgery. Comparisons of clinical features, surgical outcome and postoperative complications were conducted between two groups. Results The difference between two groups with regard to sex, age, course of diseae, tumor location, tumor size classification, facial nerve function classification and hearing classification was not statistically significant (all P>0.05). The rate of total tumor removal after surgery between two groups was not statistically significant [multimodal group: 95.8% (46/48), conventional group: 92.3% (144/156), P=0.527]. The rate of facial nerve functional preservation evaluated 2 weeks after surgery in the multimodal group was much higher than that the conventional group [81.3% (39/48) vs 64.5% (100/155), P=0.007]. The difference of practical hearing preservation between two groups was not statistically significant [6.3% (3/48) vs 5.8% (9/156), P=0.901]. The multimodal group had lower incidence of postoperative complications compared with conventional group [29.2% (14/48) vs 46.4% (72/155), P=0.034]. The follow-up period of 201 patients ranged from 6 months to 80 months, mean 22.3±4.5 months. The head enhanced MRI showed no tumor recurrence between two groups.The rate of facial nerve functional preservation evaluated 6 months after surgery in the multimodal group was much higher than the conventional group [85.4%(41/48) vs 69.3%(106/153), P=0.009]. Conclusion The multimodal technology is effective in assisting the resection of acoustic neuromas, which has certain advantages over the conventional method with respect to facial nerve functional preservation and reduction of postoperative complications. Key words: Neuroma, acoustic; Neurosurgical procedures; Facial nerve injuries; Postoperative complications; Multimodal technique