Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
J Neurooncol. 2018 Jun;138(2):417-424. doi: 10.1007/s11060-018-2812-x. Epub 2018 Feb 28.
Surgical treatment of vestibular schwannoma (VS) in patients with neurofibromatosis type 2 (NF2) along with functional preservation of cranial nerves is challenging. The aim of this study was to analyze the outcomes of hearing and facial nerve function in patients with NF2 who underwent large-size VS (> 2 cm) surgery. From 2006 to 2016, one hundred and forty NF2 patients were included with 149 large-size VS resections using retrosigmoid approach. Hearing function was classified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Preoperative and one-year postoperative facial nerve function were both assessed using the House-Brackmann (H-B) grading scale. A multivariate logistic regression was performed to identify preoperative predictors for facial function outcomes. No operative death we noted. Total tumor removal was achieved in 82.6% of the operated VSs. The anatomical integrity of the facial nerve was preserved in 67.8% of surgeries. Good facial nerve function (H-B Grades I-III) was maintained in 49.6% of patients at 12 months after surgery. Tumor size larger than 3 cm and preoperative facial weakness related with worse outcome of facial nerve function (P < 0.001; for both). Hearing preservation surgeries were attempted in 31 ears. Class B or C hearing according to the AAO-HNS criteria was maintained in 7 ears (22.5%), and measurable hearing was maintained 11 ears (35.5%). It is challenging to maintain hearing and facial nerve function in NF2 patients with large VSs. Early surgical intervention is an appropriate choice to decrease the risk of neurological functions deficit.
神经纤维瘤病 2 型（NF2）患者的前庭神经鞘瘤（VS）的手术治疗，同时保留颅神经的功能是具有挑战性的。本研究旨在分析 NF2 患者大型 VS（>2cm）手术听力和面神经功能的结果。2006 年至 2016 年，我们共纳入了 149 例采用乙状窦后入路治疗的 NF2 患者，这些患者均存在 149 例大型 VS 切除术。听力功能根据美国耳鼻喉科学-头颈外科学会（AAO-HNS）标准进行分类。术前和术后 1 年面神经功能均采用 House-Brackmann（H-B）分级量表进行评估。采用多变量逻辑回归分析术前预测面神经功能结果的因素。未观察到手术死亡病例。82.6%的手术切除肿瘤完全切除。67.8%的手术保留了面神经解剖结构的完整性。术后 12 个月，49.6%的患者面神经功能良好（H-B 分级 I-III）。肿瘤大小大于 3cm 和术前面神经无力与面神经功能预后较差相关（均 P<0.001）。尝试了 31 例听力保留手术。根据 AAO-HNS 标准，保留 B 级或 C 级听力的有 7 例（22.5%），保留可测量听力的有 11 例（35.5%）。在 NF2 患者中保留大型 VS 的听力和面神经功能具有挑战性。早期手术干预是降低神经功能缺陷风险的适当选择。
