前庭神经鞘瘤面神经功能保护策略及治疗研究进展

前庭神经鞘瘤的治疗目标已从最初的单纯切除肿瘤、降低病死率和病残率逐渐向神经功能保留、生命质量提高发展,如何实现患者获益最大化成为现代神经外科医师的责任和挑战.本文在复习文献的基础上紧密结合临床实践,重点阐述前庭神经鞘瘤术中面神经功能保护的手术技巧,总结近年来前庭神经鞘瘤手术策略的变化并展望治疗发展趋势.     

神经移植在面神经功能重建中的应用

面神经损伤引起的面部功能障碍可由多种原因造成,其不仅导致患者生活质量下降,而且进一步影响正常社交活动,因此面神经修复的主要目的在于提高患者面部对称性以及恢复社交能力,目前治疗方式包括药物治疗、康复治疗以及各类外科干预等。轻症初期面瘫患者往往会先选择保守治疗,对于保守无效或中重度面瘫的情况,神经移植是有效且可靠的治疗手段,主要术式包括咬肌神经-面神经移植(MFNN)、舌下神经-面神经移植(HFA)、跨面神经移植及其改良、联合的术式,迄今仍无统一的治疗指南。本文就面神经功能重建中不同神经移植术式进行简单地描述,重点对比其优缺点、适应证以及术后疗效,为日后临床术式选择提供一些参考。     

面神经鞘瘤一例

<正>患者男性,33岁,进行性右侧面瘫5年,进行性右耳听力下降2年。查体:右侧额纹消失,不能皱额蹙眉,右眼眼裂变大,右眼闭合不全;Bell征(+);右侧鼻唇沟变浅,口角下垂,示齿时口角偏向健侧,右耳听力下降,余(-)。颞骨高分辨CT扫描显示:右侧内听道口扩大,其内可见一类圆形膨大区,骨质未见     

面神经全程减压术治疗特发性复发性面瘫的疗效

目的：探讨面神经全程减压术对特发性复发性面瘫的疗效。方法46例特发性复发性面瘫患者分为手术治疗组（Y组,22例）和非手术治疗组（N组,24例）。采用 H‐B分级法和改进的Portmann法评判各组疗效。结果 Y组和N组面神经功能达Ⅱ级以上分别为19例（86.5％）、7例（29.2％） ,Y组满意45.5％,良好50％,面肌活动得分16.2 ± 1.93。N组满意12.5％,良好25％,面肌活动得分13.8±2.91,差异有统计学意义（P＜0.05）。结论面神经全程减压术对特发性复发性面瘫疗效较保守治疗好。     

经皮神经电刺激对急性面瘫患者神经恢复的影响

目的探讨经皮神经电刺激联合药物治疗对急性面瘫患者神经恢复的影响。方法济源市中医院2015-04-2017-06收治的124例急性面瘫患者为研究对象,采用经皮神经电刺激联合药物治疗的66例患者为观察组,常规治疗的58例患者为对照组,治疗2周后评价2组患者的临床症状及面神经功能。结果治疗后观察组额纹消失、鼻唇沟消失及鼓腮漏气患者相比治疗前明显减少(P0.05),对照组仅鼓腮漏气患者较治疗前明显减少(P0.05);组间比较治疗后观察组额纹消失、眼睑闭合露白及鼓腮漏气患者均较对照组明显减少(P0.05);治疗后观察组面神经功能分级人数分布与对照组相比差异具有统计学意义(P0.05)。结论经皮神经电刺激可在常规治疗的基础上有效改善面神经功能的恢复,进而提高其临床治疗效果。     

周围性面瘫的手术治疗浅析

周围性面瘫是临床上常见的一种疾病,大多数经过内科治疗是可以治愈的,但对于少数内科治疗效果不佳者,最终尚需手术治疗。由于病因,病程等不同,手术时机,方式等尚有进一步探讨的必要。     

DTI重建面听神经模型辅助前庭神经鞘瘤手术

目的 探讨DTI重建面听神经模型在前庭神经鞘瘤手术中对面听神经的保护作用.方法 回顾性分析31例使用MRI及DTI影像建立肿瘤及面听神经模型的前庭神经鞘瘤病例资料,根据模型制定手术计划并实施手术治疗,术中辅以神经电生理监测.结果 病人术前均可建立面听神经模型,且与术中所见解剖结构几乎完全一致.肿瘤全切29例,2例因肿瘤...     

从不同分支解剖面神经与术后面瘫的关系

本文通过对34例腮腺浅叶良性肿瘤的切除，探讨从面神经不同分支解剖而出现面瘫的可能性的大小及优缺点。     

物理疗法治疗面神经麻痹

观察98例周围性面神经麻痹患者的治疗。采用超短波56例,采用超短波合并TDP、穴位按摩和面肌运动训练42例。两级治愈率比较X2＝0．7266（P＞0．05）,差异无显著性。观察表明,物理疗法无痛苦、显效快,病程越短,效果越好。     

Morphometric study of hypoglossal nerve and facial nerve on the submandibular region in korean

Objective

This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA).

Methods

Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB).

Results

The shortest distance from the MPT to the stylomastoid foramen was 14.1±2.9 mm. The distance from the MPT to the FN origin was 8.6±2.8 mm anteriorly and 5.9±2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5±6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1±5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6±7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8±5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB.

Conclusion

This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.     

Vestibular schwannoma microsurgery with special reference to facial nerve preservation

Objective

To retrospectively study the outcomes of vestibular schwannoma (VS) resection.

Methods

Between January 2003 and December 2006, 103 consecutive patients who had undergone VS resection were included in this study. Medical records, operation summaries, follow-up data, and neuroradiological findings were analyzed. The relationship between tumor size, location, and topography relative to the facial nerve bundles was studied for a mean duration of 16 months (range: 3–39 months).

Results

Complete tumor resection in combination with anatomic preservation of the facial nerve was achieved in 101 (98.1%) cases. The facial nerve was fully preserved in 100% of cases with small or medium tumors and in 37/39 patients with large tumors. Overall, 83.5% of patients had normal or near-normal facial nerve function 3–12 months post-surgically. The mortality rate was 0%.

Conclusions

Even in large VS, preservation of facial nerve function (H-B Grade I or II) should be prioritized over total resection. For tumors >3 cm, the goal of low morbidity and maintenance of normal facial nerve function can be attained with the retrosigmoid transmeatal approach, refined microsurgical technique, and intraoperative facial nerve monitoring.     

Peripheral facial nerve paralysis in children: the value of routine diagnostic work-up studies

Acute facial nerve paralysis is a relatively common pediatric disorder. Idiopathic facial nerve palsy (Bell's palsy) has to be distinguished from other etiologies. Retrospective review of the results of routine diagnostic work-up studies of our patients, failed to reveal any clinically significant abnormalities and did not provide more data as far as etiology or indication for management. Significant history and positive findings on physical examination should direct the physician towards specific diagnostic procedures.     

Recurrence rate,time to progression and facial nerve function in microsurgery of vestibular schwannoma

Abstract

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Objective: Recurrence rate, time to progression, and facial nerve function were analysed by comparing patients with complete and near total tumor removal after suboccipital craniotomy for vestibular schwannoma surgery.

Methods: From 1996 to 2004, 118 patients with vestibular schwannoma were operated with an interdisciplinary approach. Fifty patients fulfilled the inclusion criteria and were included in the study. Progression was defined as an increase of 2 mm in the largest diameter in the magnetic resonance imaging. Preoperative tumor size, facial nerve function estimated using the House-Brackmann score (HBS), time to progression, and recurrence rate were analysed and related to the extent of resection.

Results: In 28 cases (group I), a capsular remnant was left. In 22 cases (group II), tumor removal was complete. In group I, nine patients (32·1%) showed progression. In group II, two patients (9·1%) developed a recurrent tumor, no significance (P = 0·085). In groups I and II, 53·6 and 59·6% had a good function of the facial nerve (HBS I+II), 28·6% in group I and 13·5% in group II had a moderate disturbance (HBS III+IV), and 17·9% in group I and 27·7% in group II had a poor function (HBS V+VI). There was no significant difference between median preoperative tumor size and facial nerve function within patients with HBS III and IV.

Conclusion: Complete tumor removal may be associated with a risk of functional loss, whereas near total tumor removal may be associated with a higher risk of progression.     

辨证分型治疗面神经麻痹的疗效观察

目的：探讨中医辨证分型治疗周围性面神经麻痹的疗效观察。方法采取前瞻性研究方法,选取我院2012‐10—2014‐10收治的周围性面神经麻痹患者60例为研究对象。根据就诊顺序按照随机数字表法分为辨证分型组和常规治疗组,常规治疗组给予常规药物并配合理疗治疗,辨证分型组在常规治疗组的基础上,采用不同辨证分型治疗,对治疗前后瞬目放射R1波潜伏期、面部残疾指数及治疗总有效率进行比较。结果治疗后4周,2组瞬目放射R1波潜伏期、面部残疾指数（包括躯体功能FDIP评分和社会生活功能FDIS评分）比较,差异有统计学意义（P＜0.05）;辨证分型组总有效率96.67％,常规治疗组总有效率73.33％,差异有统计学意义（ P＜0.05）。结论中医辨证分型治疗周围性面神经麻痹能够明显提高疗效,值得临床推广。     

Hemihypoglossal-facial nerve anastomosis for facial nerve palsy

BACKGROUND AND PURPOSE : Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. MATERIAL AND METHODS : The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. RESULTS : Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. CONCLUSIONS : In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.