Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA.
J Neurooncol. 2011 Apr;102(2):281-6. doi: 10.1007/s11060-010-0315-5. Epub 2010 Aug 6.
Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984-2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as "facial nerve preservation." A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09-1.49, p < 0.01; OR 1.35, 95% CI 1.10-1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted.
避免面神经麻痹是听神经鞘瘤（VS）显微手术的主要目标之一。在这项研究中，我们研究了先前涉及的预后因素（年龄、肿瘤大小、切除程度和手术入路）对面神经功能术后的意义。我们从前瞻性收集的数据库（1984-2009 年）中选择了所有接受显微切除术作为初始治疗的听神经鞘瘤患者，这些患者的病理证实为听神经鞘瘤。使用多元逻辑回归分析了手术入路、肿瘤大小、患者年龄和切除程度等变量对面神经手术后功能障碍发生率的影响。排除术前存在面神经功能障碍（House-Brackman [HB]分级 3 或更高）的患者，最后一次随访时 HB 分级为 1 或 2 定义为“面神经保留”。本研究共纳入 624 例 VS 患者。多元逻辑回归分析发现，只有术前肿瘤大小对随访≥6 个月和≥12 个月的患者的面神经预后有显著影响（OR 1.27，95%CI 1.09-1.49，p<0.01；OR 1.35，95%CI 1.10-1.67，P<0.01）。我们发现面神经功能与年龄、切除程度、手术入路或肿瘤大小之间无显著关系（当将切除程度和手术入路纳入回归分析时）。由于面神经麻痹对患者来说是一种使人虚弱和心理上毁灭性的疾病，我们建议改变具有不利肿瘤解剖结构的患者的手术侵袭性，特别是在肿瘤较大的情况下，过度积极的切除可能会使患者面临不必要的风险。如果发现肿瘤有间隔生长，可以采用放射外科进行治疗。
