听神经瘤治疗中神经功能保护的策略演进与多模态整合OA

Vestibular schwannoma(VS),as the most common benign tumor in the cerebellopontine angle region,necessitates paramount importance on nerve function preservation during treatment.This review summarizes advancements in strategies for avoiding nerve injury.In imaging,the Koos grading system guides therapeutic decision-making;diffusion tensor imaging(DTI)enables visual localization of the facial nerve;fundal fluid cap(FFC)sign predicts hearing preservation;multifactorial nomograms allow precise prediction of postoperative facial nerve function;and immediate postoperative MRI(first-day)helps differentiate between tumor residue and scar tissue.Surgical optimizations include:subperineural/bidirectional dissection techniques to reduce injury to the intermediate nerve;the semi-sitting position improves facial nerve outcomes and reduces venous air embolism;endoscopic assistance facilitates total resection of intracanalicular tumors and hearing preservation;sodium fluorescein enhances intraoperative tumor boundary delineation;augmented reality(AR)aids surgical navigation;and intraoperative electrophysiological monitoring(e.g.CNAP)increases nerve preservation rates.Advances in radiotherapy reveal:stereotactic radiosurgery(SRS)achieves a 10-year control rate of 86.7%for Koos grade Ⅳ AN;lower marginal dose and cochlear dose constraints aid hearing preservation;subtotal resection(STR)combined with delayed SRS balances tumor control and neurological function.Machine learning optimizes preoperative assessment.Future efforts should focus on integrating multimodal data to achieve the goal of"zero injury"to neurological functions.