Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Naval Medical Center, San Diego.
Otol Neurotol. 2021 Jul 1;42(6):e764-e770. doi: 10.1097/MAO.0000000000003158.
Adult patients (≥18 yrs) who underwent vestibular schwannoma resection between February 2008 and December 2017 were retrospectively reviewed. Postoperative House-Brackmann (HB) FN function was assessed on the day of surgery, daily during patients' inpatient admissions, and at postoperative clinic visits. Follow-up exceeded ≥12 months for all patients. DFP was defined as a decline (≥1 HB grade) in FN function (relative to the preoperative state) occurring between postoperative days 1 and 30.
Two hundred ninety-one patients were analyzed. Mean age was 51.5 years (±12.3) and mean tumor size 20.6 mm (±10.8). Immediate FP occurred in 61 (21%) patients, and DFP occurred in 112 (38%) patients. Tumor size was largest in patients with immediate FP (p < 0.0001). On univariate analysis, DFP was associated with better final FN outcomes (OR 0.447, p = 0.0101) compared with immediate FP. Multivariate analysis, however, showed that timing of FP was no longer significant, whereas larger tumor size and preoperative HB2 function predicted worse FN outcomes (OR 2.718, p < 0.0001 and OR 9.196, p = 0.0039, respectively). In patients with DFP, longer time to onset of palsy predicted more favorable FN outcomes.
When accounting for tumor size, the timing of onset of postoperative facial palsy does not predict final FN outcomes. In patients who develop DFP, the longer the interval between surgery and onset of weakness, the better the chances of good long-term FN function.
1）确定与听神经瘤显微切除术后迟发性面瘫（DFP）相关的临床因素。2）确定 DFP 是否预示面神经（FN）预后更差。
回顾性分析 2008 年 2 月至 2017 年 12 月期间接受听神经瘤切除术的成年患者（≥18 岁）。术后第 1 天、住院期间每天和术后门诊就诊时评估术后 House-Brackmann（HB）FN 功能。所有患者的随访时间均超过≥12 个月。DFP 定义为 FN 功能相对于术前状态（术后第 1 天至 30 天之间）下降（≥1 HB 级）。
分析了 291 例患者。平均年龄为 51.5 岁（±12.3），平均肿瘤大小为 20.6 毫米（±10.8）。立即出现面瘫的患者 61 例（21%），迟发性面瘫的患者 112 例（38%）。立即出现面瘫的患者肿瘤最大（p<0.0001）。单因素分析显示，与立即出现面瘫相比，DFP 与最终 FN 结局更好相关（OR 0.447，p=0.0101）。然而，多因素分析显示，面瘫发生的时间不再具有统计学意义，而肿瘤较大和术前 HB2 功能预测 FN 结局更差（OR 2.718，p<0.0001 和 OR 9.196，p=0.0039）。在出现 DFP 的患者中，面瘫发作的时间越长，FN 功能恢复越好。
在考虑肿瘤大小的情况下，术后面瘫发作的时间并不能预测最终 FN 结局。在发生 DFP 的患者中，手术和肌无力发作之间的间隔时间越长，FN 功能长期良好的机会越大。
