Аңдатпа
Relevance: Analysis of factors influencing the functional outcomes and complications of surgical treatment of vestibular schwannomas is important for optimizing treatment and improving patient outcomes.The study aimed to investigate factors influencing surgical outcomes for vestibular schwannomas through a retrospective analysis. Materials and Methods: The article presents the treatment outcomes of 357 patients with large vestibular schwannomas over 10 years (2012–2021). The analysis included assessments of demographic characteristics, the degree of cranial nerve involvement, the dynamics of cranial nerve functional recovery, and the incidence and causes of mortality. Results: The analysis showed that vestibular schwannomas were predominantly diagnosed in individuals of working age (mean age 45.2 ± 13.1 years), with a higher prevalence in women (60%) than in men (40%). A characteristic feature of the studied cohort was delayed presentation, with the mean tumor size at the time of surgery being 4.2 ± 1.57 cm. The duration of symptoms prior to surgery ranged from 1 to 5 years. Over the 10-year observation period, the number of surgical procedures increased by 53.6% per year. Postoperatively, trigeminal nerve involvement was observed in 35% of patients, facial nerve involvement in 48%, and lower cranial nerve involvement in 27%. During follow-up, recovery of trigeminal nerve function within 2-3 months was observed in 51.2% of cases, facial nerve function in 56.1%, and lower cranial nerve function in 70%. Over 10 years, a 15.1% reduction in the number of patients with severe facial nerve dysfunction was observed. In the majority of cases, vestibular schwannoma removal was near-total (86.8%), while subtotal resection was performed in 9.8% and partial resection in 3.4% of patients. The main causes of mortality (3.6%) were brainstem edema and ischemia (76.9%), hemorrhage in the tumor bed (15.4%), and meningoencephalitis (7.7% of cases).Conclusion: The results of the study indicate the need for measures aimed at earlier detection of vestibular schwannomas. The use of microsurgical techniques, an ultrasonic aspirator, and intraoperative neuromonitoring has improved outcomes and patients’ quality of life in the surgical treatment of vestibular schwannomas. However, intraoperative challenges remain in dissecting the tumor capsule from the cranial nerves and the brainstem in cases of pronounced adhesion, when complete tumor resection without injury to neurological structures is extremely difficult.