Hong WenMing, Cheng HongWei, Wang XiaoJie, Feng ChunGuo
Department of Neurosuregery, First Affliated Hospital, AnHui Medical Univesity, Hefei, China.
Department of Pathology, First Affliated Hospital, AnHui Medical Univesity, Hefei, China.
J Korean Neurosurg Soc. 2017 Mar;60(2):165-173. doi: 10.3340/jkns.2013.0407.001. Epub 2017 Mar 1.
To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma.
Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function.
Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I-II level) cases accounted for 75.2% (79/105), facial nerve function III-IV level cases accounted for 22.9% (24/105), and V-VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I-II level) was 74.4% (58/78).
Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient's age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.
探讨并分析听神经瘤显微手术切除后面神经功能保留的影响因素。
回顾性分析我院2006年10月至2012年1月期间的105例听神经瘤病例，该组所有患者均采用枕下乙状窦入路行听神经瘤显微手术切除。采用研究个体患者资料、门诊复查及电话随访，并运用House-Brackmann分级系统对面神经功能进行评估分析。
本研究组105例患者中，手术全切率为80.9%（85/105），次全切除率为14.3%（15/105），部分切除率为4.8%（5/105）。面神经在神经解剖学上的保留率为95.3%（100/105），死亡率为2.1%（2/105）。患者出院时的面神经功能，即即时面神经功能，按House-Brackmann分级：面神经功能优（House-Brackmann I-II级）的病例占75.2%（79/105），面神经功能III-IV级的病例占22.9%（24/105），V-VI级的病例占1.9%（2/105）。对患者进行随访1年以上，面神经功能保留优（H-B I-II级）率为74.4%（58/78）。
听神经瘤患者术后长期（≥1年）面神经功能优的保留率与手术熟练程度、术后即时面神经功能、肿瘤直径及是否使用电生理监测技术密切相关；而与患者年龄、手术入路、是否剥离内耳道、是否有囊性变、肿瘤复发、是否合并梗阻性脑积水及症状持续时间长短无明显相关性。
