Department of Otolaryngology, University of California Davis, Sacramento, California.
Department of Otolaryngology Head and Neck Surgery, The Ohio State University, Wexner Medical Center Columbus, Ohio.
Otol Neurotol. 2022 Feb 1;43(2):244-250. doi: 10.1097/MAO.0000000000003392.
Analyze delayed facial nerve palsy (DFNP) following resection of vestibular schwannoma (VS) to describe distinct characteristics and facial nerve (FN) functional course.
Prospective cohort with retrospective review.
Academic medical center.
Consecutive patients undergoing VS resection 11/2017 to 08/2020. Exclusion criteria: preoperative House-Brackmann (HB) ≥ III, postoperative HB ≥ III without delayed palsy, <30 days follow-up.
VS resection with intraoperative electromyographic monitoring.
FN outcomes utilizing the HB scale; comparison between patients with DFNP (deterioration greater than one HB grade 24 hours to 30 days postoperatively) vs. those with HBI-II throughout.
Two hundred eighty-eight patients met criteria: mean age 47.6 years, 36.1% male; 24.0% middle cranial fossa, 28.5% retrosigmoid, 47.6% translabyrinthine. DFNP occurred in 31 (10.8%) patients with average time to onset of 8.1 days. Of these, 22 (71.0%) recovered HBI-II and 3 (9.7%) recovered HBIII. Patients who experienced DFNP, on average, had larger maximum tumor diameter (23.4 vs. 18.7 mm, p = 0.014), lower rate of gross-total resection (54.8% vs. 75.5%, p = 0.014), and lower rate of ≥100 μV FN response to 0.05 mA stimulus intraoperatively (80.6% vs. 94.9%, p = 0.002). Compared to overall incidence of DFNP, translabyrinthine approach demonstrated higher incidence (15.3%, p = 0.017) while retrosigmoid lower (3.7%, p = 0.014). In multivariable logistic regression, patients with FN response ≥100 μV to 0.05 mA stimulus were 72.0% less likely to develop DFNP (p = 0.021).
Intraoperative electromyographic facial nerve response, tumor size, surgical approach, and extent of resection may play a role in development of DFNP following resection of VS. Most patients who develop DFNP recover near-normal function.
分析前庭神经鞘瘤（VS）切除术后迟发性面瘫（DFNP），以描述其独特的特征和面神经（FN）功能过程。
前瞻性队列研究，回顾性分析。
学术医疗中心。
2017 年 11 月至 2020 年 8 月连续接受 VS 切除术的患者。排除标准：术前 HB≥III 级，术后 HB≥III 级但无迟发性面瘫，随访时间<30 天。
VS 切除术联合术中肌电图监测。
利用 HB 量表评估 FN 结果；比较 DFNP 患者（术后 24 小时至 30 天，HB 分级恶化>1 级）与整个病程中 HBII 患者的 FN 预后。
288 例患者符合标准：平均年龄 47.6 岁，男性占 36.1%；中颅窝入路占 24.0%，乙状窦后入路占 28.5%，迷路入路占 47.6%。31 例（10.8%）患者发生 DFNP，平均发病时间为 8.1 天。其中，22 例（71.0%）恢复至 HBII 级，3 例（9.7%）恢复至 HBIII 级。发生 DFNP 的患者平均最大肿瘤直径更大（23.4 与 18.7mm，p=0.014），全切率更低（54.8%与 75.5%，p=0.014），术中面神经对 0.05mA 刺激的≥100μV 反应率更低（80.6%与 94.9%，p=0.002）。与总体 DFNP 发生率相比，迷路入路的发生率更高（15.3%，p=0.017），而乙状窦后入路的发生率更低（3.7%，p=0.014）。多变量逻辑回归分析显示，面神经对 0.05mA 刺激的反应≥100μV 的患者发生 DFNP 的可能性降低 72.0%（p=0.021）。
术中肌电图面神经反应、肿瘤大小、手术入路和切除程度可能与 VS 切除术后 DFNP 的发生有关。大多数发生 DFNP 的患者可恢复接近正常的功能。
