1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
2Department of Otorhinolaryngology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic ofChina.
J Neurosurg. 2018 Feb;128(2):631-638. doi: 10.3171/2016.9.JNS16997. Epub 2017 Apr 7.
OBJECTIVE The aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system. RESULTS Two hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002). CONCLUSIONS Cable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue-aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.
目的:本研究旨在回顾电缆移植桥接外侧颅底手术中面神经(FN)的技术和结果。
方法:作者回顾性评估了 1987 年 6 月至 2015 年 5 月期间在意大利的一个四级转诊中心因颅底肿瘤切除而牺牲神经后行电缆移植桥接的患者数据。所有患者均采用外侧颅底入路切除肿瘤。采用 House-Brackmann(HB)分级系统评估手术前后的面神经功能。
结果:213 例患者符合研究条件。平均随访时间为 44.3 个月。最常见的病理类型是前庭神经鞘瘤(83 例[39%]),其次是 FN 肿瘤(67 例[31%])。面神经肿瘤中断神经的发生率最高(102 例中有 67 例[66%])。术前 FN 功能正常(HB 分级 I)的患者为 105 例(49.3%),轻度(HB 分级 II)的患者为 19 例(8.9%)。在最后一次术后随访时,213 例患者中有 108 例(50.7%)恢复到 III 级神经功能。术前 FN 的 HB 分级对结果有显著影响(p = 0.002)。
结论:电缆移植桥接是一种方便且被广泛接受的立即修复 FN 的方法。在大量患者中进行的研究结果表明,无缝线纤维蛋白胶辅助吻合技术可获得良好的效果。术后能达到的最佳效果是 HB 分级 III。术前 FN 功能正常时,术后获得良好结果的机会增加。桥接后小脑脑桥角生长缓慢的肿瘤有良好的预后。
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