Divisions of1Neurosurgery and.
3Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Neurosurg Pediatr. 2021 Mar 12;27(5):566-571. doi: 10.3171/2020.9.PEDS20372. Print 2021 May 1.
Facial palsy can be caused by masses within the posterior fossa and is a known risk of surgery for tumor resection. Although well documented in the adult literature, postoperative facial weakness after posterior fossa tumor resection in pediatric patients has not been well studied. The objective of this work was to determine the incidence of postoperative facial palsy after tumor surgery, and to investigate clinical and radiographic risk factors.
A retrospective analysis was conducted at a single large pediatric hospital. Clinical, radiographic, and histological data were examined in children who were surgically treated for posterior fossa tumors between May 1, 1994, and June 1, 2011. The incidence of postoperative facial weakness was documented. A multivariate logistic regression model was used to analyze the predictive ability of clinicoradiological variables for facial weakness.
A total of 163 patients were included in this study. The average age at surgery was 7.4 ± 4.7 years, and tumor pathologies included astrocytoma (44%), medulloblastoma (36%), and ependymoma (20%). The lesions of 27 patients (17%) were considered high grade in nature. Thirteen patients (8%) exhibited preoperative symptoms of facial palsy. The overall incidence of postoperative facial palsy was 26% (43 patients), and the incidence of new postoperative facial palsy in patients without preoperative facial weakness was 20% (30 patients). The presence of a preoperative facial palsy had a large and significant effect in univariate analysis (OR 11.82, 95% CI 3.07-45.44, p < 0.01). Multivariate logistic regression identified recurrent operation (OR 4.45, 95% CI 1.49-13.30, p = 0.01) and other preoperative cranial nerve palsy (CNP; OR 3.01, 95% CI 1.24-7.29, p = 0.02) as significant risk factors for postoperative facial weakness.
Facial palsy is a risk during surgical resection of posterior fossa brain tumors in the pediatric population. The study results suggest that the incidence of new postoperative facial palsy can be as high as 20%. The presence of preoperative facial palsy, an operation for recurrent tumor, and the presence of other preoperative CNPs were found to be significant risk factors for postoperative facial weakness.
面瘫可由颅后窝内的肿块引起，是肿瘤切除手术的已知风险。尽管在成人文献中有详细记载，但儿童患者颅后窝肿瘤切除术后出现的术后无力尚未得到很好的研究。本研究的目的是确定肿瘤手术后出现术后面瘫的发生率，并研究临床和影像学危险因素。
在一家大型儿科医院进行回顾性分析。对 1994 年 5 月 1 日至 2011 年 6 月 1 日期间接受颅后窝肿瘤手术治疗的儿童进行临床、影像学和组织学数据检查。记录术后面部无力的发生率。采用多变量逻辑回归模型分析临床影像学变量对面瘫的预测能力。
共有 163 例患者纳入本研究。手术时的平均年龄为 7.4±4.7 岁，肿瘤病理包括星形细胞瘤（44%）、髓母细胞瘤（36%）和室管膜瘤（20%）。27 例（17%）患者的病变被认为具有高级别性质。13 例（8%）患者术前有面瘫症状。术后面瘫的总发生率为 26%（43 例），无术前面瘫的患者新发性面瘫的发生率为 20%（30 例）。术前面瘫在单因素分析中有较大且显著的影响（OR 11.82，95%CI 3.07-45.44，p<0.01）。多变量逻辑回归分析发现，再次手术（OR 4.45，95%CI 1.49-13.30，p=0.01）和其他术前颅神经麻痹（CNP；OR 3.01，95%CI 1.24-7.29，p=0.02）是术后面瘫的显著危险因素。
面瘫是儿童颅后窝脑肿瘤手术切除的风险。研究结果表明，新发性术后面瘫的发生率可能高达 20%。术前面瘫、复发性肿瘤手术以及其他术前颅神经麻痹的存在被认为是术后面瘫的显著危险因素。
