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Vol. 15. Issue 5.
Pages 439-446 (January 2004)
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Vol. 15. Issue 5.
Pages 439-446 (January 2004)
Tratamiento neuroquirúrgico de los neurinomas del acústico sin indicación de tratamiento con radiocirugía
Neurosurgical treatmentof acoustic neuromas without indication for radiosurgery
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J.M. González-Darder
, J.V. Pesudo-Martínez, R. Feliu-Tatay, J.M. Borrás-Moreno
Servicio de Neurocirugía. Hospital General de Castellón. Castellón de la Plana
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Resumen

El propósito de este trabajo es revisar la problemática de los neurinomas del acústico mayores de 8cc de volumen o 2,5cm de diámetro máximo en el ángulo pontocerebeloso, que no son susceptibles de tratamiento con radiocirugía. Se han incluido un total de 18 lesiones, con un volumen medio de 27.4cc, lo que equivale a una lesión de unos 3,8cm en sus tres diámetros. El seguimiento medio es de 48.7 meses. No hubo mortalidad. En todos los casos se consiguió la exéresis completa de la lesión sin recidivas, con conservación anatómica del nervio facial en el 66.7% de los casos y recuperación funcional (grados I-II de House-Brackmann) en el 27.8%, ninguno con grado I. Como secuelas definitivas, en todos los pacientes hubo cófosis, en dos casos hipostesia trigeminal con anestesia corneal y en un caso afectación cerebelosa. Se concluye señalando que la morbilidad de la exéresis de los neurinomas del acústico de gran tamaño es muy alta, es especial la afectación del nervio facial, por lo que es necesario diseñar estrategias especialmente dirigidas a minimizarlas.

Palabras clave:
Neurinoma del acústico
Nervio facial
Abordaje suboccipital
Abstract

The aim of this paper is to review the specific problems of the microsurgical management of the acoustic neuromas not suitable for radiosurgical treatment, that is measuring more than 8cc in volume or 2,5cm in máximum diameter in the cerebelopontine angle. A total of 18 lesions have been included with a mean volume of 27.4cc, representing a lesion measuring 3,8cm in its theee main diameters. The mean follow-up has been 48.7 months. There has been no mortality. All lesions were competely excised without recurrences. The ana-tomic conservation of the facial nerve was achieved in the 66.7% of the cases but the functional recovery (House-Brackmann grades I-II) was reached only in the 27.8%, without any grade I case. As permanent deficit all patients had postoperative cophosis, two had trigeminal hyposthesia with corneal anesthesia and one had a cerebellar deficit. The main conclussion is that the microsurgical radical resection of large acoustic neuromas not suitable for radiosurgical treatment is followed by a high postoperative morbidity mainly related with the facial nerve lesion. Therefore, it seems rationale to design specific strategies directed to reduce and alleviate these permanent deficits.

Keywords:
Acustic neuroma
Facial nerve
Suboccipital approach

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