Sargent E W, Kartush J M, Graham M D
Department of Otolaryngology--Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA.
Am J Otol. 1995 Jul;16(4):457-64.
Delayed facial palsy occurs after approximately 15% of acoustic neuroma resections. Whereas in most cases facial nerve function recovers satisfactorily, in about 12% of cases delayed facial palsy may have a poor functional recovery. The fate of facial nerve function was studied in 55 consecutive translabyrinthine acoustic neuroma resections, 23 of whom underwent meatal facial nerve decompression (MFND) at the time of tumor resection. The facial nerve results also were reviewed in 19 middle cranial fossa resections, of whom 14 underwent MFND. There was a bimodal distribution of the delayed palsies, with one group having the onset of palsy within hours to 2 days after surgery and the second group having onset of palsy up to 17 days after surgery. The poorest recoveries were seen in the first group. Although the effect was not statistically significant due to the small sample size, the chance of facial weakness in patients who underwent MFND after translabyrinthine surgery was about 40% less than in those who did not undergo decompression. The apparent protective effect of MFND was increased when the confounding factors of tumor size and degree of resection were taken into account, although the effect was not statistically significant. The duration of palsy was shorter and ultimate recovery better among the patients who underwent facial nerve decompression than in those who did not. Of the translabyrinthine patients who underwent MFND, 100% had House-Brackmann grade I-II function at 2 years, whereas 87% of patients who did not have MFND had grade I-II function and 13% had grade III-IV function. Without MFND, 57% of translabyrinthine patients whose onset of facial palsy was within 2 days of surgery had grade III-IV facial nerve function.
约15%的听神经瘤切除术后会出现迟发性面瘫。虽然在大多数情况下面神经功能能令人满意地恢复，但在约12%的病例中，迟发性面瘫可能功能恢复较差。对55例连续经迷路听神经瘤切除术患者的面神经功能转归进行了研究，其中23例在肿瘤切除时接受了耳道内面神经减压术（MFND）。还回顾了19例中颅窝切除术患者的面神经结果，其中14例接受了MFND。迟发性面瘫呈双峰分布，一组在术后数小时至2天内出现面瘫，另一组在术后长达17天出现面瘫。第一组的恢复最差。尽管由于样本量小，该效应无统计学意义，但经迷路手术后接受MFND的患者出现面部无力的几率比未接受减压的患者低约40%。当考虑肿瘤大小和切除程度等混杂因素时，MFND的明显保护作用有所增强，尽管该效应无统计学意义。接受面神经减压术的患者面瘫持续时间较短，最终恢复情况优于未接受减压的患者。在接受MFND的经迷路手术患者中，100%在2年时House-Brackmann分级为I-II级功能，而未接受MFND的患者中87%为I-II级功能，13%为III-IV级功能。未经MFND，面瘫在术后2天内出现的经迷路手术患者中，57%有III-IV级面神经功能。
