Lee Seunghoon, Seol Ho Jun, Park Kwan, Lee Jung-Il, Nam Do-Hyun, Kong Doo-Sik, Cho Yang-Sun
Department of Neurosurgery-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurosurgery-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
World Neurosurg. 2016 May;89:215-22. doi: 10.1016/j.wneu.2016.01.038. Epub 2016 Jan 28.
To examine the relationship between immediate postoperative facial palsy and long-term facial palsy and identify a treatment strategy for vestibular schwannoma considering long-term outcomes of facial nerve function and tumor control.
Patients (N = 385) who underwent surgery in a single institution were reviewed retrospectively; 12 patients with neurofibromatosis, 6 with preoperative radiosurgery, and 14 with multiple surgeries were excluded. The generalized estimating equation method was used to show the correlation between immediate and later postoperative facial palsy and to identify the cutoff grade of immediate postoperative facial palsy.
The tumor control rates for 1 year, 3 years, and 5 years were 88.7%, 83.9%, and 80.0%. Preservation of facial function above House-Brackmann (H-B) grades 1 and 2 was achieved in 47.9% of patients immediately postoperatively, in 50.1% after 1 month, and in 74.5% after >2 years. The immediate postoperative facial palsy grade showed a statistically significant relationship with the facial palsy grade on long-term follow-up (P < 0.001). H-B grade 3 immediate postoperative facial palsy was identified as the cutoff grade that showed the most significant relationship between the grade of immediate postoperative facial palsy and the grades above the cutoff (H-B grade 1-3) on long-term follow-up (P < 0.001).
H-B grade of immediate postoperative facial palsy can predict facial palsy at long-term follow-up. H-B grade 3 immediate postoperative facial palsy is the lowest tolerable grade that guarantees functional improvement on long-term follow-up. Planned facial nerve preservation surgery followed by radiosurgery is thought to be optimal treatment in patients with vestibular schwannoma for both tumor control and facial nerve function.
探讨术后即刻面瘫与长期面瘫之间的关系，并根据面神经功能的长期预后和肿瘤控制情况确定前庭神经鞘瘤的治疗策略。
回顾性分析在单一机构接受手术的患者（N = 385例）；排除12例神经纤维瘤病患者、6例术前接受放射外科治疗的患者以及14例接受多次手术的患者。采用广义估计方程法来显示术后即刻面瘫与后期面瘫之间的相关性，并确定术后即刻面瘫的临界分级。
1年、3年和5年的肿瘤控制率分别为88.7%、83.9%和80.0%。术后即刻，47.9%的患者面神经功能保留在House-Brackmann（H-B）1级和2级以上；术后1个月时为50.1%；术后2年以上时为74.5%。术后即刻面瘫分级与长期随访时的面瘫分级具有统计学显著相关性（P < 0.001）。术后即刻H-B 3级面瘫被确定为临界分级，该分级在术后即刻面瘫分级与长期随访时高于临界值的分级（H-B 1-3级）之间显示出最显著的相关性（P < 0.001）。
术后即刻面瘫的H-B分级可预测长期随访时的面瘫情况。术后即刻H-B 3级面瘫是保证长期随访时功能改善的最低可耐受分级。对于前庭神经鞘瘤患者，计划性面神经保留手术联合放射外科治疗被认为是实现肿瘤控制和面神经功能的最佳治疗方法。
