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Inicio Acta Otorrinolaringológica Española Complicaciones y secuelas en la cirugía de los neurinomas del acústico
Información de la revista
Vol. 58. Núm. 10.
Páginas 470-475 (Diciembre 2007)
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Vol. 58. Núm. 10.
Páginas 470-475 (Diciembre 2007)
Artículos originales
DOI: 10.1016/S0001-6519(07)74969-5
Acceso a texto completo
Complicaciones y secuelas en la cirugía de los neurinomas del acústico
Complications and Sequelae in Acoustic Neuroma Surgery
Visitas
26643
Andrés Cocaa,??
Autor para correspondencia
acocapelaz@yahoo.es

Correspondencia: Dr. A. Coca Pelaz. Valdés, 10, 2.° E. 33012 Oviedo. Asturias. España.
, Justo R. Gómeza, José L. Llorentea,b, Juan P. Rodrigoa,b, Faustino Núñeza, María A. Sevillaa, Carlos Suáreza,b
a Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. Asturias. España
b Instituto Universitario de Oncología del Principado de Asturias. Oviedo. Asturias. España
Este artículo ha recibido
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Información del artículo
Objetivo

Evaluar las complicaciones y secuelas de la cirugía del schwannoma vestibular, en virtud del tamaño tumoral.

Pacientes y método

Se realiza un estudio retrospectivo de 120 pacientes afectos de neurinomas del acústico, a los que se practicó resección microquirúrgica de la lesión entre noviembre de 1994 y septiembre de 2006. Se recogen datos del tamaño tumoral, la extensión de la resección, la preservación de los nervios facial y coclear, las complicaciones y las secuelas vestibulares. Se determina el grado de preservación de la audición según la clasificación de Gardner-Robertson.

Resultados

Entre las citadas fechas se intervinieron en 39 neurinomas pequeños (< 1,5cm), 59 de tamaño medio (1,5-3cm) y 22 grandes (> 3cm). La resección total de la lesion se consiguió en 106 (88,3 %) de los 120 casos. Se alcanzó una conservación anatómica del nervio facial y functional en el seguimiento a largo plazo en 103 (85,4 %). La función del nervio coclear se conservó (grados 1 y 2 de la clasificación de Gardner-Robertson) en el 54,4 % de los schwannomas de menos de 1,5cm de diámetro con audición válida. Fallecieron 2 pacientes por complicaciones postoperatorias (tasa de mortalidad, 1,6 %) y en 15 (12,5%) se desarrolló una fístula de líquido cefalorraquídeo.

Conclusiones

Pese a la notable mejora en los resultados de la cirugía de los neurinomas del acústico, todavía presenta una tasa apreciable de complicaciones y secuelas. Por ello debe sopesarse en cada caso particular su realización en función de las circunstancias concurrentes y valorar la posibilidad de otras alternativas como la conducta expectante o la radiocirugía.

Palabras clave:
Neurinoma del acústico
Nervio facial
Schwannoma
Neurinoma
Ángulo pontocerebeloso
Preservación auditiva
Monitorización intraoperatoria
Objective

To evaluate the complications and sequelae of acoustic neuroma surgery, according to tumour size.

Patients and method

A retrospective analysis of 120 patients who underwent microsurgical resection of vestibular schwannomas between November 1994 and September 2006 was undertaken. Tumour size, extent of removal, preservation of facial and cochlear nerves, complications, and sequelae were considered. The degree of hearing preservation after surgery was determined by the Gardner-Robertson classification.

Results

There were 39 small (< 1.5cm), 59 medium (1.5-3cm), and 22 large tumours (> 3cm). Gross total resection was accomplished in 106 cases (88.3 %). The facial nerve was anatomically and functionally preserved in 103 cases on long-term follow-up (85.4 %). The cochlear nerve was functionally preserved (Gardner-Robertson class 1 and 2) in 54.4 % of the small tumours with useful preoperative hearing. Two patients died due to postoperative complications (mortality rate, 1.6 %), and 15 (12.5 %) developed a CSF leak.

Conclusions

Despite the progress in the surgical treatment of acoustic neuromas, a considerable rate of complications and sequelae still remains. Therefore, there is a need to balance pros and cons of surgery in each patient according to the concurrent circumstances, as well as to consider other therapeutic strategies such as radiosurgery or a wait-and-see policy.

Key words:
Acoustic neuroma
Facial nerve
Schwannoma
Neuroma
Cerebellopontine angle
Hearing preservation
Intraoperative monitoring
El Texto completo está disponible en PDF
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Los autores no manifiestan ningún conflicto de intereses.

Copyright © 2007. Elsevier España S.L.
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