Analysis of the influencing factors of short-term and long-term facial nerve function after vestibular schwannoma resection via suboccipital retrosigmoid approach
10.3760/cma.j.cn115330-20231015-00148
- VernacularTitle:枕下乙状窦后入路前庭神经鞘瘤术后短期和长期面神经功能的影响因素分析
- Author:
Junwei REN
1
;
Jian XU
;
Xiang HUANG
;
Ming XU
;
Mingyu CHEN
;
Ying WANG
;
Wei WANG
;
Ping ZHONG
Author Information
1. 复旦大学附属华山医院神经外科 国家神经疾病医学中心 上海市脑功能重塑及神经再生重点实验室 复旦大学神经外科研究所 复旦大学上海医学院，上海 200040
- Keywords:
Vestibular schwannoma;
Microsurgery;
Facial nerve function;
Monitoring, intraoperative;
Rehabilitation training
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2023;58(12):1183-1190
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience of facial nerve(FN) preservation in microsurgical treatment of vestibular schwannoma (VS) resection via suboccipital retrosigmoid approach and to analyze the influencing factors of facial function prognosis in short-term and long-term period.Methods:Patients with VS who underwent microsurgery via suboccipital retrosigmoid approach by the skull base surgery team in Huashan Hospital from January 2013 to February 2018 were enrolled. A total of 308 patients were included in this study, including 132 males and 176 females. The average age was 47.9 year-old (Range: 17-79 year-old). The patient′s clinical data and FN function prognosis were recorded. Univariate and multivariate analysis by SPSS 23.0 statistical software were performed to evaluate the factors affecting facial function prognosis and its recovery.Results:Gross total resection was achieved in 304 cases, and subtotal resection was in 4 cases. The facial nerve preservation rate anatomically was 99.4%. The facial nerve of 2 cases was thin due to large tumor compression and severed, and a one-stage reconstruction was performed during surgery.Of the 308 patients, 300 cases were successfully followed up, and 8 cases were lost to follow-up. The mean follow-up time was 52 months. In short-term (2 weeks after surgery), satisfactory facial nerve function (House-Brackmann (H-B) grade Ⅰ-Ⅱ) was achieved in 96 cases, and 212 cases were unsatisfactory function (H-B grade Ⅲ-Ⅵ). After 1 year, 198 were satisfactory function and 97 were unsatisfactory. After 3 years, 219 were satisfactory function and 75 were unsatisfactory. Five years later, 155 were satisfactory function and 34 were unsatisfactory. According to the results of logistic regression analysis, the impact factors of FN function in short-term were tumor size ( P=0.011) and stimulation threshold (ST) of EMG monitoring ( P<0.001). The impact factors in long-term were tumor size ( P=0.005), ST of EMG monitoring ( P=0.005) and FN rehabilitation training. Conclusions:Tumor diameter is an independent factor related to FN function, and the larger the tumor, the worse the postoperative FN function. The ST of EMG (ST≤0.05 mA) can predict short-term and long-term FN function. The systematic facial rehabilitation training can effectively promote the recovery of FN after surgery.
