Fujita Yuichi, Uozumi Yoichi, Fujimoto Yosuke, Nagashima Hiroaki, Kohta Masaaki, Tanaka Kazuhiro, Kimura Hidehito, Fujita Atsushi, Kohmura Eiji, Sasayama Takashi
Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Neurosurgery, Kinki Central Hospital, Itami, Hyogo, Japan.
J Neurooncol. 2025 Mar 13. doi: 10.1007/s11060-025-04984-4.
Tumor morphology critically influences facial nerve (FN) outcomes following vestibular schwannoma (VS) surgery. This study aimed to develop a nomogram based on preoperative features for preoperative prediction of FN outcomes after VS surgery.
A retrospective analysis included patients with sporadic VS who underwent surgical resection via the retrosigmoid approach. Tumor size was assessed using the Koos grade, the intrameatal components using the fundal fluid cap (FFC) sign, and the cerebellopontine angle cisternal components using our modified morphological subclassification. Logistic regression analysis was performed to construct a nomogram for predicting immediate postoperative FN function.
A total of 265 patients with VS met the inclusion criteria. Of these patients, 62 (23.4%) had poor FN function (House-Brackmann grade ≥ III) immediately after surgery. Univariate logistic regression analysis identified the Koos grade (p = 0.001), FFC sign (p = 0.023), and morphological subtype (p < 0.001) as significant predictors of poor FN function immediately after surgery. In multivariate logistic regression analysis, the FFC sign (OR 2.07, p = 0.042) and morphological subtype (OR 8.21, p < 0.001) remained statistically significant independent predictors of poor FN function. A nomogram constructed based on these indicators demonstrated good discrimination in the training cohort (area under the curve [AUC] 0.80), internal validation cohort (AUC 0.79), and external validation cohort (AUC 0.97).
A simple and reliable nomogram incorporating the Koos grade, FFC sign, and morphological subtype accurately predicts the risk of FN injury during surgery aimed at total resection of VS. This clinically straightforward tool can assist in patient counseling and development of more individualized surgical strategies to improve FN outcomes in patients with VS.
肿瘤形态对前庭神经鞘瘤（VS）手术后的面神经（FN）预后有至关重要的影响。本研究旨在基于术前特征开发一种列线图，用于术前预测VS手术后的FN预后。
一项回顾性分析纳入了通过乙状窦后入路接受手术切除的散发性VS患者。使用Koos分级评估肿瘤大小，使用基底液帽（FFC）征评估内耳道成分，使用我们改良的形态学亚分类评估桥小脑角池成分。进行逻辑回归分析以构建预测术后即刻FN功能的列线图。
共有265例VS患者符合纳入标准。在这些患者中，62例（23.4%）术后即刻FN功能较差（House-Brackmann分级≥Ⅲ级）。单因素逻辑回归分析确定Koos分级（p = 0.001）、FFC征（p = 0.023）和形态学亚型（p < 0.001）是术后即刻FN功能较差的显著预测因素。在多因素逻辑回归分析中，FFC征（OR 2.07，p = 0.042）和形态学亚型（OR 8.21，p < 0.001）仍然是FN功能较差的统计学显著独立预测因素。基于这些指标构建的列线图在训练队列（曲线下面积[AUC] 0.80）、内部验证队列（AUC 0.79）和外部验证队列（AUC 0.97）中显示出良好的区分度。
一个简单可靠的列线图，纳入Koos分级、FFC征和形态学亚型，能够准确预测旨在完全切除VS的手术中FN损伤的风险。这个临床操作简便的工具可以帮助患者咨询，并制定更个性化的手术策略，以改善VS患者的FN预后。
