Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute, XuanWu Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2021 Jun;150:e400-e407. doi: 10.1016/j.wneu.2021.03.024. Epub 2021 Mar 16.
Facial nerve (FN) function preservation is the primary goal during vestibular schwannoma (VS) resection. Many factors are linked to postoperative FN outcomes. In the present study, we evaluated the association between FN length and VS surgical outcomes.
We included 70 consecutive patients who had undergone VS microsurgery between October 2019 and November 2020. The clinical data were prospectively obtained from the patients. The relative FN (rFN) length was obtained by subtracting the contralateral FN length from the ipsilateral FN length as measured using DSI Studio software (available at: http://dsi-studio.labsolver.org/).
The postoperative FN function was House-Brackmann grade I in 47 of the 70 patients (67.1%), grade II in 10 (14.3%), and grade III in 13 (18.6%). Gross total resection (GTR) was performed in 61 patients (87.1%). A residual tumor was retained to preserve FN function in 9 of the 70 patients (12.9%), and rFN length was measured (mean diameter, 20.8 mm; range, 2.5-51.5]). On multivariate analysis, the rFN length was significantly associated with the extent of tumor resection. The receiver operating characteristic curve indicated that the cutoff value for rFN length to predict for intraoperative near total resection versus GTR was 36.6 mm, with a specificity and sensitivity of 93.4% and 88.9%, respectively.
The rFN length is important for predicting surgical outcomes. An rFN length >36.6 mm might indicate difficulty in achieving GTR with preservation of FN function. Therefore, the rFN length could become an objective indicator for neurosurgeons to predict the difficulty of GTR to preserve FN function.
面神经（FN）功能的保留是听神经鞘瘤（VS）切除的首要目标。许多因素与术后 FN 结果相关。在本研究中，我们评估了 FN 长度与 VS 手术结果之间的关系。
我们纳入了 2019 年 10 月至 2020 年 11 月期间连续 70 例接受 VS 显微手术的患者。前瞻性地从患者处获得临床数据。使用 DSI Studio 软件（可在以下网址获得：http://dsi-studio.labsolver.org/）测量相对 FN（rFN）长度，即从对侧 FN 长度中减去同侧 FN 长度。
70 例患者中术后 FN 功能为 House-Brackmann Ⅰ级 47 例（67.1%），Ⅱ级 10 例（14.3%），Ⅲ级 13 例（18.6%）。61 例患者（87.1%）行大体全切除（GTR）。为保留 FN 功能，70 例患者中有 9 例（12.9%）保留肿瘤残余，测量 rFN 长度（平均直径 20.8mm；范围 2.5-51.5mm）。多变量分析显示，rFN 长度与肿瘤切除程度显著相关。受试者工作特征曲线表明，rFN 长度预测术中近全切除与 GTR 的截断值为 36.6mm，特异性和敏感性分别为 93.4%和 88.9%。
rFN 长度对于预测手术结果很重要。rFN 长度＞36.6mm 可能提示在保留 FN 功能的情况下难以实现 GTR。因此，rFN 长度可能成为神经外科医生预测保留 FN 功能的 GTR 难度的客观指标。
