Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California at San Diego, La Jolla, California, USA.
School of Medicine, University of California at San Diego, La Jolla, California, USA.
Otolaryngol Head Neck Surg. 2021 May;164(5):1085-1093. doi: 10.1177/0194599820961389. Epub 2020 Oct 13.
To identify clinical predictors of facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS).
Prospective cohort study.
Academic medical center.
Consecutive patients undergoing VS resection from November 2017 to October 2019 were included. FN function was evaluated with the House-Brackmann (HB) scale and stratified into good (HB I-II) and poor (HB III-VI) function. Analyses included descriptive statistics, correlation, and logistic regression.
Of 256 patients who met criteria (mean age, 47.7 years; 62.5% female), 227 (88.7%) achieved good FN function postoperatively and 238 (93.0%) at latest follow-up (mean, 154.8 days). Operative approaches consisted of translabyrinthine (50.8%), retrosigmoid (25.0%), and middle fossa craniotomies (24.2%). Extent of resection was decided intraoperatively, and gross or near total resection was accomplished in 237 (92.6%) cases. Postoperative HB grade correlated with latest HB grade (0.615, < .001). Factors associated with good postoperative FN function included small tumor size (≤15 mm; odds ratio [OR], 2.425; = .042), gross or near total resection (OR, 3.170; = .041), and ≥100-µV intraoperative FN electromyographic response to a 0.05-mA stimulus (OR, 22.242; < .001). Factors associated with good FN function at latest follow-up included gross total resection (OR, 7.764; = .003) and ≥100-µV FN electromyographic response (OR, 8.518; < .001), accounting for surgical approach and tumor size.
Microsurgical resection of VS can be accomplished with excellent FN outcomes. Gross total resection and ≥100-µV intraoperative FN electromyographic response predicted excellent FN outcomes. Immediate postoperative FN function is a prognosticator of long-term FN function.
确定听神经瘤（VS）显微切除后面神经（FN）预后的临床预测因素。
前瞻性队列研究。
学术医疗中心。
纳入 2017 年 11 月至 2019 年 10 月连续接受 VS 切除术的患者。FN 功能采用 House-Brackmann（HB）量表评估，并分为良好（HB I-II）和不良（HB III-VI）功能。分析包括描述性统计、相关性和逻辑回归。
符合条件的 256 例患者中（平均年龄 47.7 岁；62.5%为女性），227 例（88.7%）术后 FN 功能良好，238 例（93.0%）在末次随访时（平均 154.8 天）良好。手术方法包括经迷路（50.8%）、乙状窦后（25.0%）和中颅窝开颅术（24.2%）。切除范围在术中决定，237 例（92.6%）达到大体或近全切除。术后 HB 分级与末次 HB 分级相关（0.615， <.001）。与术后 FN 功能良好相关的因素包括肿瘤较小（≤15mm；优势比[OR]，2.425； =.042）、大体或近全切除（OR，3.170； =.041）和术中 0.05mA 刺激时≥100-µV 的 FN 肌电图反应（OR，22.242； <.001）。与末次随访时 FN 功能良好相关的因素包括大体全切除（OR，7.764； =.003）和≥100-µV 的 FN 肌电图反应（OR，8.518； <.001），这些因素与手术方法和肿瘤大小有关。
VS 的显微切除术可获得良好的 FN 预后。大体全切除和≥100-µV 的术中 FN 肌电图反应可预测良好的 FN 预后。术后即刻 FN 功能是长期 FN 功能的预后因素。
