三叉神经肿瘤术后三叉神经感觉根病变的结果。

Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve.

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.

Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China.

出版信息

Acta Neurochir (Wien). 2023 Oct;165(10):2885-2893. doi: 10.1007/s00701-023-05735-y. Epub 2023 Aug 15.

DOI:10.1007/s00701-023-05735-y

PMID:37581723

Abstract

OBJECTIVE

To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve.

METHODS

A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded.

RESULTS

This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved.

CONCLUSION

Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.

摘要

目的

观察累及三叉神经的肿瘤手术后三叉神经术后神经病的演变和结局。

方法

本研究为前瞻性观察研究，纳入 2018 年 10 月至 2019 年 2 月期间由资深作者手术证实累及三叉神经的 25 例肿瘤患者。记录术前和术后三叉神经功能状态和临床资料。

结果

本研究包括 18 例脑膜瘤和 7 例三叉神经鞘瘤。在脑膜瘤病例中，术前 55.6%的患者报告面部感觉功能障碍，33.3%表现为眼部不适，5.6%有咀嚼肌萎缩。术后所有患者均出现面部感觉异常，94.4%诉眼干，1 例（5.56%）出现角膜炎。此外，1 例（5.56%）患者出现新发咀嚼肌无力。随访时，50.0%的患者报告面部感觉异常改善，1 例（5.56%）患者恶化。35.3%的患者眼干缓解，1 例（5.56%）患者角膜炎缓解。然而，1 例（5.56%）患者发生神经源性角膜炎。总体而言，55.6%的患者出现轻度咀嚼肌无力但无肌肉萎缩。在神经鞘瘤病例中，术前 28.6%的患者出现面部感觉异常，42.9%表现为眼部不适，1 例（14.3%）诉咀嚼功能障碍。术后 85.7%的患者报告面部感觉异常和眼干，1 例（16.7%）患者出现角膜炎。随访时，66.7%的患者面部感觉异常改善，28.6%的患者眼干缓解，1 例（16.7%）患者角膜炎恢复。然而，1 例（16.7%）患者出现新发神经源性角膜炎。1 例（16.7%）患者咀嚼功能障碍缓解，但 42.9%患者出现轻度恶化。另 1 例（14.3%）患者出现面部麻醉且未改善。