Department of Neurosurgery, Kyungpook National University Hospital, 50, Samduk-2-ga, Jung-gu, Daegu, 700-721, South Korea.
J Neurosurg. 2013 Mar;118(3):566-70. doi: 10.3171/2012.10.JNS12747. Epub 2012 Oct 26.
The purpose of this study was to evaluate the function of the nervus intermedius, the nonmotor component of the facial nerve, following modern Gamma Knife surgery (GKS) for the treatment of vestibular schwannoma.
Sixty-five consecutive patients at our center underwent GKS as a primary treatment option for vestibular schwannoma between 2005 and 2010. The authors interviewed patients with a functional questionnaire to evaluate the function of the nervus intermedius before and after radiosurgery from their subjective point of view. Data from 50 patients treated using GKS for a unilateral vestibular schwannoma were obtained.
Nine (18%) of 50 patients presented with at least one preradiosurgical disturbance of the nervus intermedius caused by the vestibular schwannoma itself, with dysfunctions of lacrimation, salivation, nasal secretion, and taste. Of the 41 patients without preradiosurgical disturbances, 9 (22%) experienced the onset of at least one new disturbance after GKS. Specifically for each dysfunction, of the 45 patients without a lacrimal disturbance before GKS, 5 (11.1%) had a new lacrimal disturbance after GKS. New onset of a salivary disturbance after GKS was reported in 3 (6.2%) of 48 patients. In 1 patient (2%), increased nasal secretion was noted 1 year after GKS. Five (10.6%) of 47 patients without a preradiosurgical taste disturbance experienced the symptom after GKS. No facial palsy developed in any patient before or after GKS. There was no significant correlation between postradiosurgical nervus intermedius dysfunction and tumor size, margin dose, or patient age.
The authors demonstrated that 22% of patients undergoing modern GKS for vestibular schwannoma experience various disturbances of nonmotor components of the facial nerve as a result of the radiosurgery. Through this study, we can provide useful information about the likelihood of certain postradiosurgical symptoms for vestibular schwannoma.
本研究旨在评估现代伽玛刀手术（GKS）治疗前庭神经鞘瘤后面神经中间神经的功能。
2005 年至 2010 年期间，我们中心的 65 例连续患者选择 GKS 作为前庭神经鞘瘤的主要治疗选择。作者通过功能问卷对患者进行采访，从主观角度评估放射外科手术后中间神经的功能。获得了 50 例单侧前庭神经鞘瘤患者接受 GKS 治疗的数据。
50 例患者中有 9 例（18%）因前庭神经鞘瘤本身存在至少一种术前中间神经功能障碍，表现为泪液、唾液、鼻分泌物和味觉功能障碍。在 41 例无术前功能障碍的患者中，9 例（22%）在 GKS 后出现至少一种新的功能障碍。具体而言，在 45 例 GKS 前无泪液功能障碍的患者中，5 例（11.1%）在 GKS 后出现新的泪液功能障碍。在 48 例无术前唾液功能障碍的患者中，有 3 例（6.2%）出现 GKS 后新的唾液功能障碍。1 例（2%）患者在 GKS 后出现鼻腔分泌物增加。在 47 例无术前味觉障碍的患者中，5 例（10.6%）在 GKS 后出现该症状。在 GKS 前后，没有患者出现面瘫。放射外科手术后中间神经功能障碍与肿瘤大小、边缘剂量或患者年龄无显著相关性。
作者表明，22%的接受现代 GKS 治疗前庭神经鞘瘤的患者因放射治疗而出现面神经非运动成分的各种功能障碍。通过这项研究，我们可以为前庭神经鞘瘤患者提供有关某些放射后症状发生可能性的有用信息。
