Irving R M, Viani L, Hardy D G, Baguley D M, Moffat D A
Department of Otoneurological Surgery, Addenbrooke's Hospital, Cambridge, England.
Laryngoscope. 1995 Aug;105(8 Pt 1):809-13. doi: 10.1288/00005537-199508000-00007.
The results of facial nerve outcome following vestibular schwannoma removal have generally ignored the sensory component of the nerve. This lack of reporting occurs partly because the distress relating to these functions is less obvious to the surgeon, and partly because the facial nerve grading systems currently used do not include the functions of the nervus intermedius. We have estimated the frequency and nature of abnormalities of nervus intermedius function following vestibular schwannoma removal using a retrospective questionnaire. Questionnaires were mailed to 257 patients and correctly completed and returned by 224 (87%) of the patients. Prior to surgery 5 (2%) of the patients complained of crocodile tears, 9 (4%) noted dryness of the eye, and 15 (6%) complained of an abnormality of taste. Postoperative crocodile tears occurred in 98 (44%), an absence or significant reduction in the production of tears was noted in 162 (72%), and a taste abnormality, either a significant reduction or an alteration in character, was noted in 107 (48%). The onset of crocodile tears approximated to a bimodal distribution, and the recovery of nervus intermedius functions was variable. This study has demonstrated that nervus intermedius abnormalities are common following vestibular schwannoma removal. It also documents their natural history and discusses the underlying pathophysiological mechanisms. We suggest that appropriate preoperative counseling be given to all patients undergoing surgery and that the functions of the nervus intermedius be included in the surgical reporting of facial nerve results in cerebellopontine angle surgery.
前庭神经鞘瘤切除术后面神经功能的结果通常忽略了神经的感觉成分。缺乏这方面的报告部分原因是这些功能相关的不适对外科医生来说不那么明显，部分原因是目前使用的面神经分级系统未包括中间神经的功能。我们通过回顾性问卷调查评估了前庭神经鞘瘤切除术后中间神经功能异常的频率和性质。问卷邮寄给了257名患者，224名（87%）患者正确填写并返回。术前，5名（2%）患者主诉有鳄鱼泪，9名（4%）患者注意到眼睛干燥，15名（6%）患者主诉味觉异常。术后98名（44%）患者出现鳄鱼泪，162名（72%）患者泪液分泌减少或显著减少，107名（48%）患者出现味觉异常，表现为显著减退或性质改变。鳄鱼泪的发生近似双峰分布，中间神经功能的恢复情况各异。本研究表明，前庭神经鞘瘤切除术后中间神经异常很常见。它还记录了其自然病程并讨论了潜在的病理生理机制。我们建议对所有接受手术的患者进行适当的术前咨询，并将中间神经的功能纳入桥小脑角手术面神经结果的手术报告中。
