Yawn Robert J, Dedmon Matthew M, Xie Deborah, Thompson Reid C, O'Malley Matthew R, Bennett Marc L, Rivas Alejandro, Haynes David S
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
J Neurol Surg B Skull Base. 2019 Jun;80(3):283-286. doi: 10.1055/s-0038-1669941. Epub 2018 Sep 6.
To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma. Tertiary skull base center. Retrospective chart review. Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House-Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17-67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7-3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1-3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2-6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function ( = 0.018). A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.
描述前庭神经鞘瘤手术切除后发生迟发性面神经麻痹（DFNP）患者的发病率和临床病程。 三级颅底中心。 回顾性病历审查。 分析了2010年至2015年间在单一中心接受前庭神经鞘瘤手术切除的246例连续患者。在这些患者中，22例（8.9%）发生了DFNP，这里定义为术后即刻House-Brackmann（HB）分级≤3的患者在30天内功能恶化至少2个HB分级。DFNP患者的平均年龄为47.2岁（范围：17 - 67岁），16例（73%）为女性。肿瘤最大径的平均大小为2.1 cm（范围：0.7 - 3.5 cm）。在每个病例结束时，在脑干刺激面神经。术后即刻面神经功能平均为HB 1.8（范围：1 - 3）。术后3周随访时面神经功能平均为4.4（范围：2 - 6）。1年后，8例患者（36%）恢复至HB 1级功能，10例患者（46%）恢复至HB 2级，2例患者（9%）为HB 3级。其余2例患者未恢复功能，最后一次随访时为HB 6级。术后初始面神经功能（HB 1或HB 2）与恢复至正常（HB 1）功能的改善相关（P = 0.018）。 大多数发生迟发性麻痹的患者将恢复出色的面神经功能。然而，应告知患者，尽管神经先前功能正常且解剖结构完整，但仍有一小部分患者长期无法恢复功能。
