Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Otol Neurotol. 2011 Dec;32(9):1548-53. doi: 10.1097/MAO.0b013e318232e46e.
Early nerve-sparing tumor resection is designed to minimize facial deficits associated with facial nerve schwannomas. This report aimed to determine optimal treatment approaches and timing in patients with facial nerve schwannomas, especially those with good facial function.
Clinical decision making is complicated in patients with good facial nerve function because classical surgical treatment consists of excision of the tumor along with the involved nerve segment, followed by grafting or primary anastomosis, which can result in permanent facial deficits.
Since 1995, we have conducted a nerve-preserving technique on 15 patients with facial nerve schwannomas to obtain better results after our experience with the 10 patients who underwent tumor resection and/or facial nerve reconstruction before 1995 and evaluated the surgical outcomes of all 25 patients between 1990 and 2008. The House-Brackmann (HB) grading system for facial nerve function was used to assess preoperative and postoperative functions with follow-up magnetic resonance imaging to monitor for tumor recurrence.
At the final functional assessment, 7 patients had no change in facial function, 2 had improved, and 6 had worsened. Specifically, 4 patients had normal facial function, 8 had HB Grade II, and 3 had HB Grade III. To date, no clinical or radiologic evidence of recurrence has been detected in any of the patients, all of whom underwent postoperative enhanced magnetic resonance imaging at least 3 years after surgery.
Facial nerve-preserving technique is recommended for resection of facial nerve schwannomas, especially in patients with good preoperative facial function. Compared with the resection-and-reconstruction technique, this method can prevent delays in presurgical deterioration of the neural fascicle and may result in better postoperative facial function.
早期神经保护肿瘤切除术旨在最大限度地减少与面神经神经鞘瘤相关的面部缺陷。本报告旨在确定面神经神经鞘瘤患者的最佳治疗方法和时机，尤其是那些面部功能良好的患者。
对于面神经功能良好的患者，临床决策变得复杂，因为经典的手术治疗包括切除肿瘤和受累的神经节段，然后进行移植或直接吻合，这可能导致永久性的面部缺陷。
自 1995 年以来，我们对 15 例面神经神经鞘瘤患者进行了神经保护技术，在 1995 年之前对 10 例接受肿瘤切除术和/或面神经重建的患者进行了经验总结后，获得了更好的结果，并对 1990 年至 2008 年间的所有 25 例患者的手术结果进行了评估。采用 House-Brackmann（HB）面神经功能分级系统评估术前和术后功能，同时进行随访磁共振成像以监测肿瘤复发情况。
在最终的功能评估中，7 例患者的面神经功能无变化，2 例患者有所改善，6 例患者恶化。具体来说，4 例患者面神经功能正常，8 例患者为 HB Ⅱ级，3 例患者为 HB Ⅲ级。迄今为止，所有患者均未发现任何临床或影像学复发迹象，所有患者均在术后至少 3 年进行了增强磁共振成像检查。
建议对面神经神经鞘瘤进行面神经保护技术切除，尤其是对于术前面神经功能良好的患者。与切除-重建技术相比，这种方法可以防止术前神经束延迟恶化，并可能导致更好的术后面神经功能。
