听神经瘤手术中面神经的保护和修复

目的 探讨听神经瘤手术治疗中面神经的保护和修复的方法.方法 回顾性分析2004年1月至2006年12月我科收治137例听神经瘤的临床资料,其中肿瘤直径≥4.0 cm的40例中(29.20%),39例采用扩大迷路径路切除肿瘤,1例耳囊径路切除;肿瘤直径2.6～4.0 cm的64例(46.72%)中,经扩大迷路径路切除肿瘤57例,乙状窦后径路切除肿瘤7例;肿瘤直径1～2.5 cm的30例中(21.90%),经扩大迷路径路切除肿瘤19例,乙状窦后径路切除肿瘤11例,肿瘤直径<1 cm的3例(2.19%)均经颅中窝径路切除肿瘤.术中均采用面神经监测.结果 听神经瘤拿切除135例(98.54%),近全切除2例(1.46%);面神经解剖保留110例(80.3%),断离27例,全部为桥小脑角段,其中15例采取面-舌下神经吻合,6例腓肠神经移植面神经桥接吻合,6例因缺损长、术中兼有后组颅神经损伤,而未能修复.术后1周面神经功能达到H-B分级Ⅰ-Ⅱ级84例(61.3%,84/137),Ⅲ-Ⅳ级38例(27.7%,38/137),Ⅴ-Ⅵ级15例(10.95%,15/137).术后6～12月面神经功能Ⅰ-Ⅱ级84例(61.3%,84/137),其中肿瘤≥4.0 cm(5/40),肿瘤2.6～4.0cm者46例(71.86%,46/64);肿瘤1～2.5 cm者30例(100%,30/30);肿瘤<1 cm者3例(100%,3/3);Ⅲ-Ⅳ级者47例(34.31%,47/137),其中,肿瘤≥4.0 cm 29例,肿瘤2.6～4.0cta18例;Ⅴ-Ⅵ级者6例(4.35%,6/137):肿瘤均≥4.0 cm.结论 听神经瘤手术中面神经的保护与肿瘤的大小、面神经的走行、术前放疗、手术径路及术者的操作技巧等相关,术中采用持续面神经监测,可提高面神经的解剖保留,继而提高面神经功能保存率.面神经的修复应视面神经断离的部位、距离及后组颅神经的损伤情况来选择修复方法.     

颞骨内面神经瘤的解剖定位和放射学特点

面神经在颞骨内走行曲折并有骨管的限制 ,周围解剖结构复杂 ,这些都使放射学难以准确描述。高分辨CT和 MRI的出现利于诊断颞骨内面神经各部位肿瘤。本文回顾分析了 30年间 88例面神经瘤解剖定位及各部位的放射学特点 ,并比较了 MRI出现前后影像学的各自特点。结果 :面神经瘤可发生于面神经走行的任何节段。多节段肿瘤 (6 3.6 % )较单节段 (36 .4 % )多见。 88例中有 2 2例侵及 3个或以上节段。高分辨 CT和 MRI有助于发现极小的面神经瘤 ,但二者不能相互替代。面神经的迷路段和膝神经节段受侵机会最大。桥小脑角和内听道的面神经瘤易与…     

听神经瘤手术同期实施面神经端端吻合

听神经瘤术中切断面神经常属不可避免,对于面神经复活来说,直接进行面神经端端吻合术其结果优于其他任何类型神经吻合术。自乳突部位将面神经改道,再行端端吻合术可于听神经瘤术中同期完成。作者自1977年10月至1990年10月为19例患者行听神经原发肿瘤切除,术中因肿瘤累及面神经而有意切断,少数则无意损伤致面神经离断,随即实施面神经端端吻合术。随访超过18个月,16例进行面神经功能检查,House分级达Ⅳ级以上。避免了进行二期较大范围的神经吻合术,且不致因Ⅶ、Ⅻ颅神经吻合而导致Ⅻ颅神经缺损。作者建议在切除听神经瘤对面神经切断的处理缺乏训练     

面神经鞘膜瘤切除同期面神经重建术后效果分析

目的 探讨面神经鞘膜瘤切除同期面神经重建手术的疗效.方法 回顾性分析自2004年1月至2015年12月确诊并行面神经鞘膜瘤切除同期行面神经重建术的42例面神经鞘膜瘤患者的临床资料,按面神经重建方法分为端端吻合术(A组,3例)、面神经移植术(B组,4例)、跨面神经移植术(C组,8例)、面神经-舌下/咬肌神经吻合术(D组,27例);分别于术后1周、3个月、半年、1年进行面神经功能H-B分级评估及Fisch评分,分析疗效.结果 跨面神经移植术组(C组)患者术后3个月的面神经功能(Fisch评分)优于术后1周,术后6个月的面神经功能优于术后3个月(均为P<0.01),术后6个月与术后1年差异无统计学意义(P>0.05);神经吻合术组(D组)患者术后1年的面神经功能(Fisch评分)优于术后6个月(P<0.05);A、B两组病例偏少,故未对该二组Fisch评分进行统计学比较.结论 本组对象中多数面神经鞘膜瘤患者肿物切除同期行面神经重建后可获得较好效果,面神经功能恢复至稳定状态所需时间较长,部分患者术后1年面神经功能仍在恢复中.     

面神经肿瘤6例临床分析

目的讨论并分析面神经肿瘤患者的临床特征、诊断以及不同类型面神经肿瘤和不同程度面瘫患者的手术方式的选择。方法回顾性分析临床资料较为完整的面神经肿瘤6例,面神经功能评估采用House-Brackmann分级(下文简称HB分级)。结果首发症状中,面瘫3例,外耳道肿物2例,听力下降1例。肿瘤病变部位位于面神经垂直段2例,水平段1例,膝状神经节、水平段1例,锥曲段、垂直段以及颞骨外段1例,中颅窝至垂直段1例。高分辨率CT(HRCT)可见面神经膨胀性生长,表现为面神经管增粗,充满软组织影,相应骨质破坏,边缘多光滑,水平段可见听小骨向外推压;磁共振成像(MRI)多表现为信号不均匀边缘光滑的肿物占位。术前面神经HB分级I级3例,II级1例,IV级1例,VI级1例。所有病例均进行手术诊治,2例行面神经活检术,2例肿瘤切除术,2例肿瘤切除后行耳大神经修复术。术后病理报告:神经鞘膜瘤5例,神经纤维瘤1例。随访15月-5年,2例面神经肿瘤活检的患者以及1例面神经肿瘤切除的患者均无面瘫发生,1例面神经肿瘤切除的患者术后HB分级由IV级变为VI级,2例面神经肿瘤切除后行耳大神经移植术的患者术前术后面瘫程度无变化。结论对面瘫发生时间长或者反复发作的患者,HRCT、MRI等影像学检查是排除肿瘤的必要手段,其治疗方案可根据其面神经功能来确定,面瘫轻的患者可考虑面神经活检与减压手术,面瘫重的患者可考虑肿瘤切除与神经移植术。     

神经导航辅助经内听道入路显微手术治疗听神经瘤

目的总结术中神经导航应用于听神经瘤的经验,探讨面听神经保留的显微外科技巧,以提高肿瘤的全切率和面听神经的保护率。方法回顾性分析应用术中神经导航技术经枕下乙状窦后-内听道入路显微外科手术治疗的31例听神经瘤。术中神经导航定位静脉窦,引导内听道后壁磨除。27例术中行脑干诱发电位监测。结果肿瘤全切31例,全切除率为100%。术中面神经解剖保留29例,面神经解剖保留率为93.6%。肿瘤切除3个月后复查,面神经功能Ⅰ～Ⅱ级27例(87.1%),Ⅲ～Ⅳ级4例(12.9%)。解剖未能保留的2例,术中均行面神经端-端吻合。无手术相关死亡病例。结论神经导航的应用有助于提高听神经瘤切除的安全性和手术疗效。熟练掌握显微手术技巧、术中神经导航和面神经电生理监测的应用是提高肿瘤全切除、面神经解剖和功能保护率的关键。     

颞骨内段面神经前移的效果分析

目的分析颞骨内段面神经移位对于面神经功能的影响,总结颞骨内段面神经移位外科技术要点。方法回顾性分析我单位2015年5月至2018年1月行侧颅底手术中未受肿瘤侵犯或轻度侵犯的患者面神经前移的临床资料,选择术前House-Brackmann(H-B)面瘫分级系统I级,且影像学评估面神经未被肿瘤包绕或包绕小于180°的病例,评估其术后面部运动(H-B分级)情况。结果共14例患者,其中颞下窝进路TypeA 9例,TypeA+B 5例。病理类型包括副神经节瘤10例(71.43%),神经鞘瘤3例(21.43%),岩尖胆脂瘤1例(7.14%)。平均随访时间23.42月(12个月至44个月)。14例(100%)术后平均5.67月时恢复至H-B I-II级。结论在面神经未收肿瘤侵犯或轻度侵犯的情况下,移位面神经导致术后永久面瘫的几率很小。面神经移位过程中保持神经被膜完整、避免神经张力过大、轻柔止血等手术技术是保护面神经功能的保证。     

听神经瘤切除与面神经功能的保存

目的探讨听神经瘤切除手术的面神经功能的保存.方法回顾性分析自1998年2月至2003年6月,在术中面神经监测下完成的听神经瘤切除手术48例,对三种手术进路的结果进行了比较.术前接受纯音测听、声阻抗测试、听觉脑干反应(ABR)、复合动作电位(CAP)及眼震电图(ENG)检查,并进行桥小脑角CT及MRI检查.术中皆进行面神经监测,面神经功能判断标准采用House-Brackmann(简称H-B)分级法.手术采用经迷路进路、乙状窦后进路和颅中窝进路三种.结果根据MRI结果,肿瘤限于内听道内者3耳,内听道外瘤体直径在1～2cm者8耳,2～3cm者12耳,大于3～5cm者25耳.48例中肿瘤完全切除者46例(96%),解剖学上保存面神经者47例(98%),术后7天内面神经功能达到H-B Ⅰ～Ⅱ级者达83%(40/48),其中乙状窦后进路组为84%(21/25),迷路进路组为83%(15/18),经颅中窝进路组为80%(4/5),各手术进路组之间基本相近.经乙状窦后进路组中有3例采用耳窥镜辅助下切除内听道内残存肿瘤,且完整保留面神经功能.结论听神经瘤切除术中应用面神经监测仪监测有助于提高面神经功能的保存率.耳窥镜辅助下克服了传统乙状窦后进路术式的难以完全暴露内听道内肿瘤的弊端.     

听神经瘤的显微外科切除及治疗策略探讨

目的探讨听神经瘤显微外科切除的手术技巧和术中面听神经保护要点及治疗策略的选择。方法分析2008年10月至2012年4月期间221例单侧听神经瘤病例,其中大型听神经瘤(直径≥3cm)183例(占82.8%),采用枕下乙状窦后入路,术中全程行面、三叉神经/和听性脑干反应监测。结果肿瘤全切及近全切除共199例(占90%),次全切除共22例(占10%)。面神经解剖保留201例(占91%),功能保留183例(占82.8%)。耳蜗神经功能保留33%。结论显微手术切除是治疗大型听神经瘤的主要方法,听神经瘤的治疗策略应该根据具体情况个性化选择,目的是患者长期高质量的生存。     

面神经血管瘤诊断及治疗

目的　研究面神经血管瘤的临床特点及影像学表现。方法　收集2006年1月～2011年12月在北京世纪坛医院面神经研究室诊治的5例面神经血管瘤患者临床资料。男2例,女3例,年龄29～44岁;5例面神经血管瘤患者,4例均行颞骨高分辨率CT（high resolution CT,HRCT）及面神经增强MRI检查,1例仅行面神经增强MRI。结果　5例患者均以突发单侧面瘫起病;左侧4例,右侧1例;5例患者均有面神经膝节段受累;面神经血管瘤在HRCT上主要表现为膝状神经节及邻近迷路段、水平段面神经骨管扩大,周围骨质边缘不连续、欠规则。较典型者呈点状或针状高密度类似蜂窝状结构;MRI上主要表现为以膝状神经节为中心的软组织结节影,伴邻近节段面神经增粗。平扫呈混杂T1、不均匀稍长T2异常信号,边界欠清,增强扫描后异常强化。结论  详细病史、结合颞骨HRCT及多平面重建、面神经增强MRI等辅助检查,有助于面神经血管瘤术前诊断;根据患者听力情况、肿瘤范围、累及部位选择适宜的手术径路,在尽可能保留面神经完整性的基础上切除肿瘤。     

Facial nerve dysfunction after parotidectomy: the role of local factors

OBJECTIVES/HYPOTHESIS: The objective was to analyze the incidence and factors associated with facial nerve dysfunction after conservative parotidectomy with facial nerve dissection. STUDY DESIGN: A retrospective unicentric study in a tertiary care center with prospective record of studied factors. METHODS: Over a 10-year period, 131 patients with normal facial nerve function underwent a superficial or total conservative parotidectomy with nerve dissection performed by one surgeon for primary benign or malignant tumors. Facial nerve function was assessed on the first postoperative day and at 1 month and 6 months after the parotidectomy. Extent of surgery, histopathological findings, tumor size, close contact of tumor with facial nerve, and sex and age of the patient were reviewed. These variables were studied in a chi2 statistical univariate and stratified analysis to determine their association with postoperative facial nerve dysfunction. RESULTS: Incidence of postoperative facial nerve dysfunction was 42.7% on the first postoperative day, 30.7% at 1 month after the parotidectomy, and 0% at 6 months after the parotidectomy. The most common dysfunction was paresis in a single nerve branch (48.2%), in particular, the marginal mandibular branch. Total parotidectomy was associated with a significantly higher incidence of facial nerve dysfunction during the first postoperative period (60.5% at day 1 and 44.7% at month 1) than superficial parotidectomy (18.2% at day 1 and 10.9% at month 1) (P < .001). In patients with total parotidectomy, close contact of the tumor with the facial nerve was found to have statistical causal relation with facial nerve weakness. In patients with superficial parotidectomy, inflammatory conditions were found as factors that increased postoperative facial nerve dysfunction. CONCLUSION: In the study series of conservative parotidectomies with facial nerve dissection, only extent of surgery and particular local conditions of nerve dissection, especially the close contact of tumor with facial nerve and inflammatory conditions, were found to be associated with postoperative facial nerve dysfunction.     

Facial Nerve Function After Petrosectomy

Objectives: Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation-decompression, forward or backward rerouting, and facial nerve suture and grafting. Study Design: Fifty-six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy. Methods: The treatment of the facial nerve included 15 denudation-compressions, 23 denudation-compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House-Brackmann grading system was used for facial nerve evaluation. Results: Normal or nearly normal facial nerve function was obtained in facial nerve denudation-decompression with and without rerouting (House-Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). Conclusions: Our results show that petrosectomy with denudation-decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.     

Intratemporal facial nerve neuroma: anatomical location and radiological features

OBJECTIVES: To present the imaging findings and anatomical locations of a series of 88 facial nerve neuromas from two centers over a 30-year period. We describe the salient radiological features of neuromas in each anatomical location and outline the ways in which modern imaging techniques have altered our perception of this entity. STUDY DESIGN: A retrospective review of tumors presenting to two tertiary care referral institutions since 1970. METHODS: The charts and available imaging of patients with the diagnosis of facial neuroma were reviewed. These patients presented to the House Ear Clinic between 1970 and 1994 and to the University of Utah Medical Center (Salt Lake City, UT) between 1986 and August 2000. We examined anatomical location to determine patterns of tumor presentation and compared the findings before and after the era of magnetic resonance imaging (MRI). RESULTS: All segments of the facial nerve were represented. Overall, multiple-segment tumors were almost twice as common (63.6%) as single-segment tumors (36.4%). Before the advent of MRI, all segments of the nerve from the cerebellopontine angle to the tympanic portion were almost equally represented (29.5%-36.3%). After MRI, the geniculate ganglion (68.2%) and labyrinthine portion (52.3%) were by far the most commonly affected areas. Before MRI, there were, on average, 1.89 segments involved per tumor. After MRI, this average number increased to 2.57 segments per tumor. Radiologically, the high-resolution computed tomography and MRI features cannot be generalized. Rather, the imaging features depend on which segments are involved. This is because of the variation in the surrounding anatomical landscape of the facial nerve in its course through the temporal bone. CONCLUSION: The more sensitive imaging provided by newer radiological techniques has altered our perception of facial neuroma. It has provided us with an increased ability to diagnose and fully evaluate this neoplasm preoperatively, allowing improved patient counseling and surgical planning.     

Facial nerve paralysis following cochlear implant surgery

OBJECTIVES: Facial nerve paralysis is a rare but devastating complication of cochlear implant surgery. The aims of the study were to define the incidence of facial nerve paralysis in our series and understand possible mechanisms of injury. STUDY DESIGN: Retrospective chart review and case reports. METHODS: Charts were reviewed of all 705 patients implanted between 1980 and 2002 at the authors' institutions to identify those with postoperative facial nerve weakness and determine incidence. For patients with facial nerve weakness, onset, degree, and timing of paralysis were noted; clinical findings were correlated to operative report findings. The method of treatment was noted, and the final facial nerve function outcome was recorded. RESULTS: Five patients (one child and four adults) were found to have postoperative facial nerve weakness, for an incidence of 0.71%. This complication was delayed in all cases, ranging from 18 hours to 19 days postoperatively. All patients were treated with steroids or steroids combined with antiviral medication, and all ultimately recovered normal facial function. CONCLUSIONS: In the study series, the incidence of facial nerve paralysis following cochlear implant surgery was 0.71%. Possible mechanisms of injury included heating injury and viral reactivation. All patients presented with a delayed facial nerve paralysis and did recover normal facial nerve function.     

面神经与前庭神经鞘膜瘤的空间位置对术后面神经功能恢复的影响

目的：探讨面神经（FN）与前庭神经鞘膜瘤（VS）空间位置对于术后FN功能恢复的影响。方法：101例单侧VS患者,采用扩大迷路径路显微全切除肿瘤,观察术中FN-VS空间位置,分为4型：第1位置为FN位于VS前方,第2位置为FN位于VS前上方,第3位置为FN位于VS上方,第4位置为FN位于VS后方。根据House-Brackmann面神经分级法评价患者术后7、30、90、180d的FN功能。结果：术中FN解剖保留率达98％,术中发现FN—VS空间位置有43％为第1位置,33％为第2位置,24％为第3位置,未发现第4位置。术后180d 73％FN功能良好,且随VS直径增大,术后FN功能良好率递减。FN—VS空间位置与术后FN功能呈显著相关,第1位置至第3位置术后FN功能良好率呈递减关系。结论：术中FN解剖保留率并不平行于术后FN功能良好率,VS直径与术后FN功能良好率相关,而FN—VS空间位置能够预测术后FN功能良好率。     

Free vascularized nerve grafting for immediate facial nerve reconstruction

OBJECTIVES/HYPOTHESIS: To obtain better functional results after reconstruction to treat facial palsy in the patients with preoperative and intraoperative factors that might inhibit functional recovery, the authors have used free vascularized nerve grafts to immediately reconstruct severed facial nerves. STUDY DESIGN: The indications for vascularized nerve grafts were 1) scarred recipient bed attributable to previous operations, 2) a history of previous irradiation at the wound, 3) facial skin defects over the nerve graft after tumor ablation, 4) patient age greater than 60 years, and 5) preoperative facial palsy. METHODS: Four types of free vascularized nerves were used. Functional recovery after reconstruction could be assessed with two facial nerve grading systems.Ten patients who underwent immediate reconstruction of severed facial nerve after ablative surgery of malignant tumors of the parotid gland were reviewed. RESULTS: Functional recovery after reconstruction could be assessed with the House-Brackmann grading system and a 40-point grading system in 6 of the 10 patients after a mean follow-up period of 29.8 months (range, 10-60 mo). Results with the House-Brackmann system were grade II in 1 patient, grade III in 4 patients, and grade IV in 1 patient; scores on the 40-point grading system were 20 in 1 patient, 22 in 3 patients, 24 in 1 patient, and 28 in 1 patient. CONCLUSION: The study results indicated that muscle movement recovers satisfactorily after free vascularized nerve grafting. Although a study comparing vascularized nerve grafts and conventional nerve grafts would be necessary to confirm the superiority of vascularized nerve grafts, free vascularized nerve grafts are effective for immediate reconstruction of the severed facial nerve in patients with preoperative and intraoperative factors that might inhibit functional recovery.     

Facial nerve in parotidectomy: a topographical analysis

OBJECTIVE: Establish normative data concerning parotidectomy and facial nerve dissection and determine the relationship between the length of the facial nerve dissected during parotidectomy and subsequent facial nerve paresis. STUDY DESIGN: Prospective mapping of facial nerve during parotidectomy and comparison with postoperative facial nerve function. METHODS: A prospective observational study of 78 patients who underwent 79 parotidectomy procedures. During each procedure, various topographical measurements were recorded. These measurements included the distance from the tragal pointer to the main trunk of the facial nerve, the distance to the pes anserinus, and length of each segmental branch dissected. In addition, a designation of the patient's tumor location was made by drawing a line from the ear canal to the nasal spine. Tumors above this line were designated anatomic zone A and those below the line were designated anatomic zone B. Finally, facial nerve function was quantified at a 1-week follow-up visit using the House-Brackmann Scale. RESULTS: The distance from the main trunk of the facial nerve to the tragal pointer was significantly (P < .000) less than the previously accepted standard of 1 cm. The cervical and marginal mandibular branches had more nerve dissected, whereas the eye and forehead branches were the least dissected. Results of an independent t test and logistic regression (P = .01, both) indicated that patients with temporary facial nerve paresis had a significantly greater amount of nerve dissected than patients without temporary facial nerve paresis. Patients with short-term facial nerve dysfunction had significantly (P < .01) more total nerve dissected (136.73 mm vs. 94.73 mm) than patients without short-term facial nerve dysfunction. Patients with nerve dissection lengths at the third quartile (130.0 mm) were 3.8 times more likely to experience temporary facial nerve paresis than patients with nerve dissection lengths at the first quartile (64.5 mm). CONCLUSIONS: The axiom that the main trunk of the facial nerve is located 1 cm from the tragal pointer may need to be modified to less than 1 cm. The cervical and marginal mandibular branches had more nerve dissected, whereas the eye and forehead branches were the least dissected. Facial nerve paresis after parotidectomy is associated with the length of the facial nerve dissected during the procedure. The greater the length of facial nerve dissected, the higher the chance of facial nerve paresis, albeit temporarily, in this particular series of patients.     

Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results

Abstract

Background: The long-term outcomes of total facial nerve decompression (TFND) in severe idiopathic recurrent facial palsy (IRFP) are still unknown.

Aims/objectives: To explore the long-term follow-up results of TFND in IRFP.

Materials and methods: Twenty-eight patients suffering from severe IRFP were enrolled. Patients were offered conventional therapy or TFND and were categorized into control or operation group. The follow-up lasted for at least 6 years. Comparison was made in terms of relapse of facial palsy as well as outcomes of facial nerve.

Results: There were 16 participants in operation group, whose follow-up lasted for 10.4?±?1.3 years. In contrast, there were 12 participants in control group, who were followed up lasted for 11.2?±?1.2 years. No participants suffered relapse in the operation group while seven out of 12 participants (58.3%) encountered relapse with regard to control group (p?<?.05). In terms of facial nerve results, 16 out of 18 participants (88.9%) reached satisfactory outcomes of facial nerve (HB grade I or II) while only four out of 12 participants (33.3%) achieved satisfactory outcomes in control group (p?<?.05).

Conclusions and significance: In terms of severe IRFP, TFND can defend patients from relapse in a long period, and enhance recovery of facial nerve.     

耳大神经移植修复面神经缺损的临床研究

目的:探讨采用耳大神经移植修复面神经缺损的可行性。方法:采用耳大神经移植修复面神经缺损14例,手术方式为经乳突进路面神经移植术。以House-Brackmann(HB)分级法评估手术前和手术后面神经功能。结果:在8例颞骨骨折所致面神经麻痹的患者中,颞骨骨折的类型均为纵形骨折,面神经受累及的部位主要在第2膝及其附近,术前面神经功能均为Ⅵ级。3例面神经肿瘤中面神经呈多节段受累,病理结果均为神经鞘膜瘤,术前面神经功能Ⅲ级1例、Ⅴ级2例。医源性损伤2例患者原发病均为胆脂瘤中耳炎,损伤部位分别为面神经乳突段和第2膝。1例钢水烧伤面神经损伤部位在面神经鼓室段,术前面神经功能Ⅵ级。除3例患者失访外,其余患者术后面神经功能恢复Ⅲ级4例、Ⅳ级3例、Ⅴ级2例、Ⅵ级2例。结论:颞骨骨折是导致面神经离断的最常见原因,以耳大神经移植修复面神经缺损是一种实用有效的方法,面神经移植后神经功能恢复最佳可达HBⅢ级。     

Management of facial nerve schwannoma in patients with favorable facial function

OBJECTIVE: We report six cases of facial nerve schwannomas in which surgical management allowed the preservation of facial nerve function. Specifically, this paper reports that a stripping surgery may provide favorable functional outcomes. STUDY DESIGN: A retrospective review of preoperative and postoperative data for six patients with facial nerve schwannoma that had normal facial nerve function or a House-Brackmann grade II facial palsy before the surgery. METHODS: Stripping surgery, which removed the schwannoma from the remaining nerve fascicle, was attempted on the six patients. Postoperative facial nerve function and imaging (magnetic resonance imaging) were evaluated. RESULTS: Stripping surgery with gross total tumor removal of the mass was performed in four cases. In the two remaining cases, the stripping surgery was not possible, and decompression alone was performed. Favorable preservation of facial function was achieved in all six cases. CONCLUSION: It was possible to preserve facial function after surgery to remove facial nerve schwannoma. We suggest that stripping surgery, focused on the preservation of continuity of the facial nerve, may be attempted for facial nerve schwannoma in which favorable facial function has been preserved.