Di Perna Giuseppe, De Marco Raffaele, Baldassarre Bianca Maria, Lo Bue Enrico, Cofano Fabio, Zeppa Pietro, Ceroni Luca, Penner Federica, Melcarne Antonio, Garbossa Diego, Lanotte Michele Maria, Zenga Francesco
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
Skull Base and Pituitary Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy.
Front Oncol. 2023 Jun 12;13:1153662. doi: 10.3389/fonc.2023.1153662. eCollection 2023.
Patients' quality of life (QoL), facial nerve (FN), and cochlear nerve (CN) (if conserved) functions should be pursued as final outcomes of vestibular schwannoma (VS) surgery. In regard to FN function, different morphologic and neurophysiological factors have been related to postoperative outcomes. The aim of the current retrospective study was to investigate the impact of these factors on the short- and long-term FN function after VS resection. The combination of preoperative and intraoperative factors resulted in designing and validating a multiparametric score to predict short- and long-term FN function.
A single-center retrospective analysis was performed for patients harboring non-syndromic VS who underwent surgical resection in the period 2015-2020. A minimum follow-up period of 12 months was considered among the inclusion criteria. Morphological tumor characteristics, intraoperative neurophysiological parameters, and postoperative clinical factors, namely, House-Brackmann (HB) scale, were retrieved in the study. A statistical analysis was conducted to investigate any relationships with FN outcome and to assess the reliability of the score.
Seventy-two patients with solitary primary VS were treated in the period of the study. A total of 59.8% of patients showed an HB value < 3 in the immediate postoperative period (T1), reaching to 76.4% at the last follow-up evaluation. A multiparametric score, Facial Nerve Outcome Score (FNOS), was built. The totality of patients with FNOS grade A showed an HB value < 3 at 12 months, decreasing to 70% for those with FNOS grade B, whereas 100% of patients with FNOS grade C showed an HB value ≥ 3. The ordinal logistic regression showed three times increasing probability to see an HB value ≥ 3 at 3-month follow-up for each worsening point in FNOS score [Exp(B), 2,999; p < 0.001] that was even more probable [Exp(B), 5.486; p < 0.001] at 12 months.
The FNOS score resulted to be a reliable score, showing high associations with FN function both at short- and long-term follow-up. Although multicenter studies would be able to increase its reproducibility, it could be used to predict the FN damage after surgery and the potential of restoring its function on the long-term period.
患者的生活质量（QoL）、面神经（FN）和蜗神经（CN）（若保留）功能应作为前庭神经鞘瘤（VS）手术的最终结果来追求。关于FN功能，不同的形态学和神经生理学因素与术后结果相关。本回顾性研究的目的是调查这些因素对VS切除术后短期和长期FN功能的影响。术前和术中因素的结合导致设计并验证了一个多参数评分，以预测短期和长期FN功能。
对2015年至2020年期间接受手术切除的非综合征性VS患者进行单中心回顾性分析。纳入标准包括至少12个月的随访期。在研究中检索了肿瘤形态学特征、术中神经生理学参数以及术后临床因素，即House-Brackmann（HB）分级。进行统计分析以研究与FN结果的任何关系，并评估评分的可靠性。
在研究期间共治疗了72例孤立性原发性VS患者。术后即刻（T1）共有59.8%的患者HB值<3，在最后一次随访评估时达到76.4%。构建了一个多参数评分，即面神经结果评分（FNOS）。FNOS A级的所有患者在12个月时HB值<3，FNOS B级的患者降至70%，而FNOS C级的患者100%的HB值≥3。有序逻辑回归显示，在3个月随访时，FNOS评分每恶化一分，出现HB值≥3的概率增加两倍[Exp(B)，2.999；p<0.001]，在12个月时更有可能[Exp(B)，5.486；p<0.001]。
FNOS评分是一个可靠的评分，在短期和长期随访中均与FN功能高度相关。尽管多中心研究能够提高其可重复性，但它可用于预测手术后的FN损伤以及长期恢复其功能的潜力。
