Glieme Franziska, Haddad Lisa, Arlt Felix, Vychopen Martin, Seidel Clemens, Barrantes-Freer Alonso, Güresir Erdem, Wach Johannes
Department of Neurosurgery, University Hospital Leipzig, University of Leipzig, 04103 Leipzig, Germany.
Comprehensive Cancer Center Central Germany, Partner Site Leipzig, 04103 Leipzig, Germany.
J Clin Med. 2024 Sep 8;13(17):5319. doi: 10.3390/jcm13175319.
Facial nerve paralysis is a severe dysfunction after vestibular schwannoma (VS) surgery. This monocentric study analyzed 61 patients who underwent sporadic VS surgery in a standardized manner. The primary endpoint was the facial nerve outcome (FNO) at 3 months after VS surgery. FNO was dichotomized into "good" (House-Brackmann (HB) score ≤ 2) and "poor" (HB > 2). Poor FNO was observed in 11 patients (18.0%) at 3 months after VS surgery. Radiomic tumor shape features were analyzed, and the AUC of elongation in the prediction of a poor HB at 3 months was 0.70 (95% CI: 0.56-0.85, = 0.03) and the optimum threshold value (≤/>0.35) yielded a sensitivity and specificity of 64.0% and 75.4%, respectively. Multivariable logistic regression analyses considering the extent of resection (</≥93.4%), preoperative tumor volume (</≥2.6 cm), age (</≥55), sex (female/male), and elongation (≤/>0.35) revealed that more elongated VSs (≤0.35; OR: 5.8; 95%CI: 1.2-28.2; = 0.03) and those with an increased EoR (≥93.4%; OR: 6.5; 95%CI: 1.0-42.5; = 0.05) are independently associated with poorer FNO at 3 months after surgery. Highly elongated VS shape seems to be a risk factor for worsened facial nerve outcome at 3 months after surgery for Koos grade 3 and 4 tumors.
面神经麻痹是前庭神经鞘瘤(VS)手术后的一种严重功能障碍。这项单中心研究分析了61例以标准化方式接受散发性VS手术的患者。主要终点是VS手术后3个月时的面神经结果(FNO)。FNO被分为“良好”(House-Brackmann(HB)评分≤2)和“不良”(HB>2)。VS手术后3个月时,11例患者(18.0%)出现不良FNO。分析了放射组学肿瘤形状特征,预测3个月时HB不良的伸长率的AUC为0.70(95%CI:0.56-0.85,P = 0.03),最佳阈值(≤/>0.35)产生的敏感性和特异性分别为64.0%和75.4%。多变量逻辑回归分析考虑了切除范围(</≥93.4%)、术前肿瘤体积(</≥2.6 cm)、年龄(</≥55岁)、性别(女性/男性)和伸长率(≤/>0.35),结果显示,形状更细长的VS(≤0.35;OR:5.8;95%CI:1.2-28.2;P = 0.03)以及切除范围增加的VS(≥93.4%;OR:6.5;95%CI:1.0-42.5;P = 0.05)与术后3个月时较差的FNO独立相关。对于Koos 3级和4级肿瘤,高度细长的VS形状似乎是术后3个月面神经结果恶化的一个危险因素。