Lye R H, Dutton J, Ramsden R T, Occleshaw J V, Ferguson I T, Taylor I
J Neurosurg. 1982 Dec;57(6):739-46. doi: 10.3171/jns.1982.57.6.0739.
A series of 33 patients with 35 acoustic nerve tumors is reviewed. Tumor size was estimated from computerized tomography (CT) scans, and its influence on anatomical and functional preservation of the facial nerve was assessed. Six tumors (one invading the petrous bone, three medium and two large tumors) were not detected on CT scans. The translabyrinthine approach was used in seven instances (one small and six medium tumors) and the suboccipital transmeatal approach for 28 tumors (seven medium and 21 large tumors). Anatomical preservation of the facial nerve was achieved in 83% of operations for tumor removal, two of which were subtotal. A further two patients underwent subtotal removal, but the facial nerve was destroyed. Large tumors carried an increased risk of damage to the facial nerve, but even in this group the nerve was preserved anatomically intact in 70% of cases. Damage to the facial nerve occurred more frequently in patients with preoperative evidence of facial weakness; however, this factor did not appear to influence functional recovery of the facial nerve, provided that the nerve was intact at the end of the operation. A simple grading system for facial nerve function is described. Ony 76% of anatomically intact facial nerves showed any evidence of function 1 month after surgery. Postoperatively, facial function improved with time. At the latest review, 45% of these patients had normal facial function or mild facial weakness (Grades I and II).
回顾了33例患有35个听神经瘤的患者。根据计算机断层扫描（CT）估计肿瘤大小，并评估其对面神经解剖结构和功能保留的影响。6个肿瘤（1个侵犯岩骨，3个中等大小和2个大肿瘤）在CT扫描中未被检测到。采用经迷路入路7例（1个小肿瘤和6个中等大小肿瘤），枕下经耳道入路28例（7个中等大小和21个大肿瘤）。在83%的肿瘤切除手术中实现了面神经的解剖保留，其中2例为次全切除。另有2例患者接受了次全切除，但面神经被破坏。大肿瘤导致面神经损伤的风险增加，但即使在这组患者中，70%的病例面神经在解剖学上保持完整。术前有面神经麻痹证据的患者面神经损伤更常见；然而，只要手术结束时神经完整，这一因素似乎并不影响面神经的功能恢复。描述了一种简单的面神经功能分级系统。术后1个月，只有76%解剖学完整的面神经显示出任何功能迹象。术后，面部功能随时间改善。在最近一次复查时，这些患者中有45%面部功能正常或有轻度面神经麻痹（I级和II级）。
