Asensi-Diaz Montserrat, Rodrigo Fernandez Raquel, Aristegui Torrano Ignacio, Nieva Pascual Ismael, Lopez Granados Carolina, Bueno Aventin Isabel, Aristegui Miguel, Martin Oviedo Carlos
Otorhinolaryngology department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, Madrid, 28009, España.
Ophtalmology department, Hospital General Universitario Gregorio Marañón, Madrid, España.
Eur Arch Otorhinolaryngol. 2025 Apr;282(4):1743-1750. doi: 10.1007/s00405-024-09053-6. Epub 2024 Nov 2.
Facial nerve palsy is one of the most important complications of vestibular schwannoma resection. When VII cranial nerve is damaged, ocular complications might appear, impacting patient´s quality of life. Therefore, standardized eye care must be a priority. This involves three key treatments: topical treatment, rehabilitation and oculoplastic surgery. The aim of this work is to review the results of oculoplastic surgery performed simultaneously with vestibular schwannoma resection in terms of vision-related quality of life, compared to deferred surgery.
The study involved 177 patients who underwent vestibular schwannoma resection between 2015 and 2022. The incidence of facial palsy was registered. Of those patients who had the palsy, we selected 35 who also had oculoplastic surgery. 5 of them declined participating in the study. The final sample (n = 30) was divided in two groups depending on the timing of oculoplastic surgery: simultaneously- first group (n = 15) and deferred-second group (n = 15). The vision-related quality of life was measured using the NEI VFQ-25 test.
26.56% patients developed an immediate postoperative facial dysfunction, decreasing to 18.08% after one year of follow-up. Timing of oculoplastic surgery was associated with better results in quality of life; the first group of patients had a better quality of life (70.27/100) compared to the second group (53.73/100; p = 0.006). Moreover, worse results in quality of life were also associated with long-term postoperative facial palsy (p = 0.042). Current criteria for selecting patients were reliable, proving adequacy as we found worse long-term facial functions in patients who underwent simultaneous surgery (p = 0.01).
Our current criteria for selecting candidates for simultaneous oculoplastic surgery are effective. When long-term facial nerve dysfunction is expected during vestibular schwannoma resection, oculoplastic surgery should be performed simultaneously to preserve the q vision-related quality of life. Long-term severe facial palsy is associated with poor vision-related quality of life.
面神经麻痹是前庭神经鞘瘤切除术后最重要的并发症之一。当第七颅神经受损时，可能会出现眼部并发症，影响患者的生活质量。因此，标准化的眼部护理必须是首要任务。这包括三种关键治疗方法：局部治疗、康复治疗和眼部整形手术。这项工作的目的是，与延期手术相比，评估在前庭神经鞘瘤切除术中同时进行眼部整形手术在视力相关生活质量方面的效果。
该研究纳入了2015年至2022年间接受前庭神经鞘瘤切除术的177例患者。记录面神经麻痹的发生率。在这些出现面神经麻痹的患者中，我们选择了35例同时接受眼部整形手术的患者。其中5例拒绝参与研究。最终样本（n = 30）根据眼部整形手术的时间分为两组：同时手术组（第一组，n = 15）和延期手术组（第二组，n = 15）。使用NEI VFQ - 25测试评估视力相关生活质量。
26.56%的患者术后立即出现面部功能障碍，随访一年后降至18.08%。眼部整形手术的时机与生活质量的更好结果相关；第一组患者的生活质量（70.27/100）优于第二组（53.73/100；p = 0.006）。此外，生活质量较差的结果也与术后长期面神经麻痹相关（p = 0.042）。当前的患者选择标准是可靠的，证明了其充分性，因为我们发现同时进行手术的患者长期面部功能较差（p = 0.01）。
我们目前选择同时进行眼部整形手术患者的标准是有效的。当前庭神经鞘瘤切除术预计会出现长期面神经功能障碍时，应同时进行眼部整形手术以保留视力相关生活质量。长期严重面神经麻痹与较差的视力相关生活质量有关。
