大型听神经瘤手术面神经功能的保留

目的 评估大型听神经瘤显微手术治疗后远期面神经功能,分析影响术后面神经功能的因素.方法 回顾性分析2002年1月至2009年11月实施的连续176例大型听神经瘤(直径≥30mm)手术的患者资料.采用House-Brackmann(HB)面神经功能分级系统评价术前及术后远期面神经功能.肿瘤大小与面神经功能结果的关系采用线性趋势检验统计学方法进行分析.结果 肿瘤全切除168例(95.5%),术后死亡3例(1.7%).面神经完整解剖保留169例(96.0%).共随访到135例患者,失访41例.随访时间3个月～7年,平均3年.随访＞1年的96例听神经瘤面神经功能HB 1～2级79例(82.3%),其中55例巨大型(直径＞40 mm)听神经瘤患者面神经功能HB 1～2级40例(72.7%).分析显示面神经功能结果与肿瘤直径之间存在线性关系(P＜0.05).结论 经乙状窦后入路切除大型听神经瘤,绝大部分肿瘤切除后可获得优良的远期面神经功能.肿瘤大小是影响术后面神经功能的重要因素.

Abstract：

Objectiyes To evaluate the long-term facial nerve function of patients following microsurgical removal of large and huge acoustic neuroma, and to identify the factors that influence these outcomes. Methods A retrospective review was performed which included 176 consecutive patients with a large acoustic neuroma(≥30 mm)underwent a retrosigmoid craniotomy for tumor resection between January 2002 to November 2009. House-Brackmann(HB)Scale was used preoperatively and in a long-term follow-up after surgery. Test for linear trend was applied for statistic analysis. Results Complete resection was achieved in 168(95. 5%)of these 176 patients with a mortality of 1.7%. Anatomic preservation of the facial nerve was attained in 96. 0% of the patients. In the series of 96 patients who had at least 1-year follow-up(mean 3.0 years)the facial nerve function preservation(HB grade 1-2)was totally attained in 79 patients(82.3 %), and 40 of 55 patients(72. 7 %)who presented huge tumors(diameter ＞ 40 mm)among the 96 patients had facial nerve function preserved. Analysis showed that facial nerve function correlated linearly with tumor sizes(x2 = 14. 114, v, = 1, P ＜ 0. 05). Conclusions Complete removal of large and giant acoustic neuroma may abtained via retrosigmoid approach with facial nerve preservation. Excellent longterm facial function can be expected in the majority of patients who undergo microsurgical removal of vestibular schwannoma via the suboccipital retrosigmoid approach. Tumor size is a significant prognostic parameter for facial nerve function following vestibular schwannoma surgery.

Facial nerve preservation following microsurgical removal of large and huge acoustic neuroma

Objectiyes To evaluate the long-term facial nerve function of patients following microsurgical removal of large and huge acoustic neuroma, and to identify the factors that influence these outcomes. Methods A retrospective review was performed which included 176 consecutive patients with a large acoustic neuroma(≥30 mm)underwent a retrosigmoid craniotomy for tumor resection between January 2002 to November 2009. House-Brackmann(HB)Scale was used preoperatively and in a long-term follow-up after surgery. Test for linear trend was applied for statistic analysis. Results Complete resection was achieved in 168(95. 5%)of these 176 patients with a mortality of 1.7%. Anatomic preservation of the facial nerve was attained in 96. 0% of the patients. In the series of 96 patients who had at least 1-year follow-up(mean 3.0 years)the facial nerve function preservation(HB grade 1-2)was totally attained in 79 patients(82.3 %), and 40 of 55 patients(72. 7 %)who presented huge tumors(diameter ＞ 40 mm)among the 96 patients had facial nerve function preserved. Analysis showed that facial nerve function correlated linearly with tumor sizes(x2 = 14. 114, v, = 1, P ＜ 0. 05). Conclusions Complete removal of large and giant acoustic neuroma may abtained via retrosigmoid approach with facial nerve preservation. Excellent longterm facial function can be expected in the majority of patients who undergo microsurgical removal of vestibular schwannoma via the suboccipital retrosigmoid approach. Tumor size is a significant prognostic parameter for facial nerve function following vestibular schwannoma surgery.