Suboccipital surgery for acoustic neuroma

A retrospective study was performed on 106 consecutive patients with an acoustic neuroma who underwent suboccipital surgery for the first time between 1980 and 1992. Complete follow-up data were available for all the patients, including regular imaging up to 1 January 1994. Incomplete removal of the tumours was chosen in preference to radical surgery in a large proportion of the patients, to avoid the risk of postoperative morbidity. The recurrence rate in this series was 20%. Comparison of the results of suboccipital surgery to those obtained using other surgical approaches, while taking the tumour size into consideration, showed that better results can be obtained after total removal of the tumour without any additional risk to post-operative facial nerve function. The long-term results of subtotal removal using the suboccipital approach were disappointing. It is therefore necessary to review the indications for non-radical surgery in patients with an acoustic neuroma.     

Comparison of postoperative facial nerve outcomes between translabyrinthine and retrosigmoid approaches in matched-pair patients

OBJECTIVES/HYPOTHESIS: The objective was to assess whether the translabyrinthine approach for acoustic tumor removal offers better postoperative facial nerve function compared with the retrosigmoid approach. STUDY DESIGN: Retrospective case review from a tertiary otology referral center. METHODS: Patients who had undergone either retrosigmoid or translabyrinthine approach for removal of acoustic neuroma from January 1, 1980, to December 31, 1999, were included in the study. Two groups of patients were created, one containing retrosigmoid cases and the other, translabyrinthine. Attempts were made to match each retrosigmoid case to a translabyrinthine case with regard to tumor size, patient age, and date of operation. This matching served to eliminate these variables from influencing postoperative facial nerve outcomes. From an initial pool of 450 patients, 35 pairs of patients were matched for the study. Facial nerve functions were reported at immediate, 3-month, and 1-year postoperative periods. RESULTS: Patient demographics demonstrated that matched patients had almost identical tumor size, patient age, and date of operation. Comparisons of postoperative facial nerve functions between the matched groups revealed that retrosigmoid approach carried 2.86 times higher risk of facial nerve dysfunction during the immediate postoperative period. However, by 1 year, the facial nerve outcomes were similar between the two groups. CONCLUSION: Compared with the translabyrinthine approach, retrosigmoid approach carries a higher risk of postoperative facial nerve dysfunction during the immediate postoperative period. However, long-term facial nerve outcomes are identical between the two approaches.     

Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center

Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS). Study Design: Retrospective. Methods: Chart review. Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy‐one of 74 patients (95%) patients with IVN tumors achieved a House‐Brackmann (HB) grade I–III, while 35 of 35 patients (100%) with SVN tumors retained HB I–III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1‐cm tumors, and 4 of 20 patients (20%) with 1‐ to 1.5‐cm tumors. For all cases with documented facial nerve function, HB I–III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures. Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow‐up.     

神经电生理监测下听神经瘤显微手术中面神经的保护

目的总结分析术中神经电生理监测结合显微手术操作技巧在听神经瘤手术中预防面神经损伤的作用。方法选取我科2011～2012年施行乙状窦后入路显微手术的大型及中型听神经瘤（肿瘤直径≥2.4 cm）患者62例,术中应用神经电生理监测技术对手术进行综合监护,同时密切留意骨性解剖、蛛网膜解剖、神经与血管解剖关系。术后随访6个月,评估肿瘤切除程度并根据House-Brack-mann面神经功能分级对患者面神经功能进行评估。结果肿瘤全切除58例（93.5%）,次全切除4例（6.5%）;无围手术期死亡患者。面神经功能评定：Ⅰ级57例（91.9%）,Ⅱ级5例（8.1%）。结论对于大型和中型听神经瘤患者,术中进行综合电生理监护,同时操作时注意典型的解剖位置与熟练的显微手术技术,可达到较高的肿瘤全切除率,并尽可能地保全面神经功能。     

Hypoglossal‐facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision

Despite advances in neuro‐otological techniques permanent complete facial palsy may still occur in up to 10% of patients undergoing removal of cerebellopontine angle tumours. Hypoglossal‐facial nerve anastomosis is the procedure of choice in our unit for facial reanimation in such patients and below we report the results of hypoglossal‐facial nerve anastomosis performed on 29 patients. Assessment of patient benefit from hypoglossal‐facial nerve anastomosis was obtained using a questionnaire based on the Glasgow Benefit Inventory. The results showed all patients to have an improvement in their House Brackmann grade following hypoglossal‐facial anastomosis with 65% achieving grade III or better. Of the 20 patients who completed the questionnaire, 18 showed a positive benefit (median score 59.5, range 40–77). There was a significant correlation (P < 0.045) between the Glasgow benefit inventory score and House Brackmann grade. Outcome was not affected by the time interval between the acoustic neuroma surgery and performing the hypoglossal‐facial nerve anastomosis, sex or length of follow‐up. However the Glasgow benefit score was significantly influenced by age (P = 0.023) with younger patients showing more benefit independent of improvement in facial nerve function.     

Use of the KTP-532 Laser in Acoustic Neuroma Surgery

The potassium titanyl phosphate (KTP-532) laser has been applied to otologic surgery with a proven record of both safety and efficacy. The aim of this study was to demonstrate the use, safety, and advantages of laser dissection in the surgical treatment of acoustic neuromas. The authors' experience with 111 patients in whom laser surgery was used in acoustic neuroma is presented, with emphasis on surgical technique employed and facial nerve functional outcome. The method of laser dissection did not result in deleterious neurologic sequelae or laser-specific complications. In addition, laser dissection afforded certain advantages to traditional techniques, especially in larger tumors. The facial nerve functional outcome as assessed by the House-Brackmann grading system revealed that 90.2% of small tumors, 72.2% of medium tumors, and 75.0% of large tumors achieved satisfactory (grades I and II) functional results. These results compare favorably with the literature describing nonlaser dissection techniques. The observations and results reported in this article demonstrate the safety of the KTP-532 laser in the posterior cranial fossa, and specific advantages that this technology may offer to the surgical armamentarium of the neuro-otologist are outlined.     

Primary parotid malignoma surgery in patients with normal preoperative facial nerve function: outcome and long-term postoperative facial nerve function

Objectives/Hypothesis: Most patients with primary parotid cancer present with normal facial nerve function. The common surgical strategy for these patients is to perform a parotidectomy with facial nerve preservation. Nevertheless, the functional outcome for the facial nerve and oncological outcome is unclear. Study Design: Medical records of 211 patients treated from 1986 to 2000 in an university hospital were reviewed. One hundred seven patients with primary surgery for primary parotid cancer and long‐term follow‐up were analyzed retrospectively. Methods: The characteristics, treatment, and oncological outcome were evaluated using hospital chart data. All patients with postoperative facial paresis were had follow‐up with electromyography until recovery or permanent paresis became apparent. Results: Ninety‐one patients had a normal preoperative function. Facial nerve preservation during surgery by total parotidectomy was possible in 79 patients, whereas in 28 patients a radical parotidectomy was necessary. Otherwise, the oncological characteristics of both groups were not different. Directly after total parotidectomy, half of the patients presented a facial paresis but only two patients (2%) developed a permanent partial paresis. The 5‐year disease‐free rate and the 5‐ and 10‐year survival rates were 65%, 83%, and 54%, respectively. After radical parotidectomy, the results were not significantly different. The 5‐year disease‐free rate and the overall 5‐ and the 10‐year survival rates were 56%, 62%, and 42%, respectively. Conclusion: Treatment of primary parotid cancer with preoperatively normal facial nerve function by standardized parotidectomy and precise microsurgical preservation of the facial nerve is often possible. This approach demonstrates favorable oncological results with a low level of long‐term facial nerve morbidity.     

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.     

Translabyrinthine removal of large acoustic neuromas in young adults

OBJECTIVE: the authors reviewed the clinical manifestations and the surgical outcomes in a series of young patients who underwent removal of large acoustic neuromas via the translabyrinthine approach. METHODS: 40 young adults who underwent a translabyrinthine removal of acoustic neuromas 3 cm or greater in size were analyzed. The patient's age ranged from 17 to 30 years. The mean size of tumor was 4.25 cm. RESULTS: the primary symptoms are similar to those in adult but usually less intense. The average interval time between the primary symptom and the diagnosis was 17 months. A high percentage of preoperative normal hearing (35%) and good facial function (100%) were noted. Translabyrinthine approach was used in all cases. Total removal was realised in 39 patients (97.5%). The facial nerve was anatomically preserved in 37 patients (92.5%). Twenty-six patients (65%) had a good facial function (House-Brackmann grade I or II) immediately or at 1 month after surgery, 11 patients (28%) achieved grade III or IV. Three patients underwent an immediate nerve repair after tumor removal. All of them recovered to grade III or IV 1 year after surgery. Postoperative complications were minimal. CONCLUSIONS: young adults may have a rapid growth rate but usually have minimal symptoms even with a large acoustic neuroma. The translabyrinthine approach has been used successfully in removal of large acoustic tumors of young patients, with the good result of facial nerve preservation and long-term tumor control.     

Distance from acoustic neuroma to fundus and a postoperative facial palsy.

OBJECTIVE/HYPOTHESIS: Generally, patients with small acoustic neuroma have less facial palsy after its removal. The middle cranial fossa approach is mainly applied to the small acoustic neuroma and tumor size does not influence the prognosis of facial palsy. The internal auditory canal cannot be fully opened in the middle cranial fossa approach, and the facial nerve is tightly attached in the fundus. According to these anatomical factors, we hypothesized that acoustic neuromas located away from the fundus might be removed with less facial nerve damage. We investigated the distance between the acoustic neuroma and fundus and its clinical relationship. STUDY DESIGN: Retrospective study of 45 patients with acoustic neuroma who underwent a middle cranial fossa approach. METHODS: The distance between the acoustic neuroma and fundus and the tumor diameter were measured on T2-weighted and contrast-enhanced magnetic resonance images, respectively. These data were compared with the postoperative facial nerve function. RESULTS: The mean distance was 3.0 +/- 1.8 mm (range, 0-10 mm), and the mean diameter was 11.3 +/- 3.7 mm (means +/- standard deviation; range, 4-20 mm). Neither the distance nor the diameter had any correlation to the degrees of postoperative facial palsy either immediately or at 3 months after surgery. CONCLUSIONS: As far as the nerve was anatomically preserved, postoperative facial nerve function seemed to be influenced by factors other than surgical manipulation among small acoustic neuromas. Although the tumor fills in the fundus, it may not influence postoperative facial nerve function and also may not interfere with indication of the middle cranial fossa approach for removal of the acoustic neuroma.     

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.     

扩大迷路进路切除大听神经瘤18例报告

目的：探讨通过扩大的迷路进路切除大听神经瘤的方法和效果。方法：充分暴露乙状窦及其后方硬脑膜、岩上窦、颅中窝硬脑膜,暴露并下压颈静脉球,内听道周转骨质２７０℃以上切除。肿瘤切除从前下极处开始,以早期暴露脑干及脑干表面面神经,随后即从内侧向外侧解剖面神经。结果：１８例直径在３ｃｍ以上的听神经瘤（平均直径４．２ｃｍ）,均手术全切,脑组织无明显损伤。２例术后一过性脑脊液漏自愈,无颅内感染。面神经解剖及功能     

Translabyrinthine and transotic surgery for acoustic neuroma

The results and complications of translabyrinthine and transotic surgery for petrous apex lesions between 1980 and 1992 are presented. An acoustic neuroma was found in 52 patients. In 1988, the translabyrinthine approach was modified into the transotic approach and replaced the former technique. There was no mortality in this series, but two patients had mild brainstem infarcts and there was post-operative bleeding into the cerebellopontine angle in one. Cerebrospinal fluid (CSF) leakage was seen in six patients and meningitis in two. Three suffered deep vein thrombosis in their legs. There was one case each of herniation of the cerebellum and gastric bleeding. Post-operative facial nerve function was good in 88%, moderate in 10% and poor in 2%. In the case of acoustic neuromas the aim was total tumour removal, but if there was a serious risk of damaging the nerve anatomically, near total or subtotal removal was performed. During the study period, there was a gradual decrease in facial nerve morbidity and surgical complications. This was attributed to increasing experience, the modified wider approach and better post-operative care.     

A technique of mastoidectomy and meatoplasty that minimizes factors associated with a discharging mastoid cavity

OBJECTIVES: To present and assess a surgical technique designed to minimize the known causes of a discharging mastoid cavity. STUDY DESIGN: A temporal bone dissection to establish the anatomical relationships on which the surgical technique is based. A presentation of the proposed surgical technique and a prospective assessment of the technique in twenty consecutive mastoidectomies. METHODS: Five temporal bone dissections were performed to establish the relationship between the chorda tympani and the facial nerve when these structures are approached from above. The surgical technique is presented and the mastoid cavities of twenty consecutive patients assessed. The assessment included measurement of the facial ridge height, "kidney-shape" of the cavity, size of the cavity, size of the meatus, and state of the tympanic membrane. RESULTS: In the temporal bone dissections the vertical height between the chorda tympani and the facial nerve at 3/9 o'clock was a mean of 2.01 mm. Nineteen of the 20 consecutive mastoid cavities (95%) performed with the presented technique remained well healed and dry. The mean facial ridge height was 2.7 mm at 3/9 o'clock and 4.8 mm at 6 o'clock. The kidney-shaped measurement was 1.45 mm. The mean size of the cavities was 2.6 mm and 18 of the 20 patients (90%) had an intact tympanic membrane. The mean largest diameter of the meatus was 10.1 mm. CONCLUSIONS: The surgical technique presented produces a mastoid cavity with a low facial ridge and oval shape. These two factors have been previously identified as important in the outcome of mastoid surgery.     

Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation

Objectives: To determine whether patients with small to medium sized acoustic neuromas managed conservatively suffer reduced rates of facial nerve and hearing preservation when compared with patients undergoing primary surgery. Design: An intention‐to‐treat comparison between patients managed conservatively at first presentation and those managed with primary surgery. Setting: Tertiary referral neurotological centre in Birmingham, UK. Participants: Data were drawn from our database of 487 sporadic acoustic neuromas managed from 1997 to present day. Main outcome measures: Facial nerve status (assessed using the House‐Brackmann system) was collated for all conservatively managed patients (n = 167) and compared with that expected when calculated from primarily surgically managed tumours of equivalent size (n = 121). A chi‐square test was employed to test the statistical significance of any difference. Hearing preservation (maintenance of AAO‐HNS Class) in patients presenting with Class A or B hearing was compared between conservatively managed patients and those with primary surgical management. Results: Observed facial nerve preservation in conservatively managed patients was significantly better (P < 0.001) than expected when calculated from rates of facial nerve preservation in surgically managed patients. Hearing preservation was also significantly more successful in conservatively managed patients (Pearson chi‐square: P < 0.000). Conclusions: An initial period of conservative management is a safe and reasonable management policy in all acoustic neuromas up to 2 cm in size at the cerebello‐pontine angle. Given that there are no failsafe ways of deciding potential for growth in acoustic neuromas, initial conservative management of these tumours offers superior hearing and facial nerve preservation when compared with primary surgical treatment.     

Risk—Benefit Analysis of Using the Middle Fossa Approach for Acoustic Neuromas With >10 mm Cerebellopontine Angle Component

Objectives To evaluate hearing preservation and facial nerve (FN) outcome in the middle fossa (MF) approach for acoustic neuromas with a cerebellopontine angle (CPA) component >10 mm. Study Design Retrospective review of 193 patients. Patient Population Patients were grouped according to tumor size: intracanalicular tumors (IC; 64), 1 to 9 mm CPA extension (42), and 10 to 18 mm CPA extension (47). Additionally, a group of 40 patients (tumor size 10–18 mm CPA extension) who had undergone a translabyrinthine (TL) approach was studied to assess comparative FN outcome. Hearing and FN function were measured 1 year postoperatively. We defined the success at functional hearing preservation as AAO–HNS class B or better and good FN outcome as House‐Brackmann grade II or better. Results For IC tumors and those with up to 9‐mm CPA extension, there was no significant difference in the rate of functional hearing preservation (62.2% vs. 63.1%, P = .931) and good FN outcome (93.7% vs. 97.6%, P = .358). For tumors of 10‐ to 18‐mm CPA extension, the rate of hearing preservation (34%) was lower than the other groups (P = .006 and P = .009). In this group, the rate of good FN outcome was lower compared with the IC and 1‐ to 9‐mm tumors (80.8% vs. 93.7%, P = .037 and 97.6%, P = .012). The rate of good FN outcome following the TL approach in a comparable cohort of patients was 100% (P = .003 in comparison with 10–18 mm tumor resected with the MF approach). Conclusions When considering surgical options, patients with >10‐mm tumors should be advised that choosing the MF approach for hearing preservation carries a somewhat higher risk of persistent FN dysfunction.     

颞下窝B型径路切除侧颅底肿瘤临床分析

目的探讨颞下窝B型径路在侧颅底肿瘤中的适应证及手术效果。 方法回顾性分析2015年1月—2018年6月采用颞下窝B型径路治疗8例侧颅底肿瘤患者的临床资料,其中横纹肌肉瘤1例,成熟型畸胎瘤1例,骨巨细胞瘤1例,颞骨鳞癌1例,巨细胞修复性肉芽肿2例,胆脂瘤2例。结果3例患者病变范围主要累及颈静脉孔区、颈内动脉、岩尖;5例患者病变范围主要累及颧弓、颞下颌关节、中颅底甚至颞叶。7例单纯行颞下窝B型径路,1例患者行颞下窝B型径路联合经耳蜗径路,8例患者均完全切除病变。所有患者术后1周复查头颅MRI,均未见病变残留。4例患者术后为重度传导性或混合性听力下降,另外4例患者术后为极重度感音神经性听力下降。术前面瘫者2例,术后无加重;术前面神经功能正常者,术后2例出现面瘫,其中1例为联合经耳蜗入路患者术中将面神经进行移位,另外1例由于恶性肿瘤已侵犯面神经,术中将受侵犯的面神经切除。所有患者随访期间均无脑脊液耳漏、颅内出血,颅内感染、偏瘫、死亡等严重术后并发症。 结论颞下窝B型径路在暴露颈内动脉垂直段和水平段、岩尖等部位极具优势,同时这一径路也可用于切除累及颧弓、颞下颌关节甚至累及颞叶的侧颅底肿瘤。     

Objective Facial Motion Analysis in Patients With Facial Nerve Dysfunction

Objectives/Hypothesis To objectively measure facial motion at various facial landmarks using a video‐computer interactive system. Study Design Clinical, prospective, non‐randomized. Methods A video‐computer interactive system, The Peak Motus Motion Measurement System, was used to study linear displacement at preselected facial landmarks in the normal and abnormal face. Subjects with normal facial function (n = 34) and patients with abnormal facial function (n = 26) from various etiologies were studied. The sites studied were marked with reflective beads. Of a larger repertoire of expressions, two expressions (eyes closed and closed‐lip smile) were studied in all subjects. The percent asymmetry in facial displacement between the sides of the face was calculated. The sensitivity of this measurement to facial dysfunction was evaluated. The presence of synkinesis was examined by quantifying the displacement at facial sites that were remote to the sites primarily involved in a given facial expression. Test–retest reliability of the percent asymmetry measurement was evaluated with the paired t test. Results The video‐computer interactive approach used accurately detected and quantified gross and subtle changes in facial function. The sensitivity of the percent asymmetry measurement was 95% (both expressions) for patients with apparent facial dysfunction (House‐Brackmann rating >I/VI). In patients with facial nerve dysfunction, displacement on the presumably normal side was significantly excessive in 27% to 35%, depending on the expression. With this interactive computer‐video system, synkinesis was detected in 58% of the pathologic subjects during the eyes closed or closed‐lip smile expressions. The paired t test indicated strong test–retest reliability (r = 0.73–0.99) of the percent asymmetry measurement. Conclusions The present report indicates that this approach to the assessment of facial motion is sensitive to facial dysfunction. This computer‐video interactive system is able to quantify synkinesis. A grading system for the magnitude of synkinesis, based on the magnitude of the displacement at remote facial sites, is proposed. The common occurrence of excessive facial motion on the presumably normal side of affected individuals indicates that patients with facial paralysis often overcompensate by exaggerating the normal side in an effort to move the affected side. This system is of value in the objective measurement of normal facial function and may prove a useful tool to quantify the outcomes of various medical and surgical treatments for facial nerve dysfunction.     

面神经瘤27例临床分析

目的:分析面神经瘤患者的临床表现和诊断,讨论不同部位面神经瘤手术方法的选择。方法:对1999-09-2006-12临床资料完整的27例面神经瘤患者进行回顾性研究。结果:27例面神经瘤患者经术后病理证实20例为面神经鞘膜瘤(74.1%),4例为面神经纤维瘤(14.8%),3例为面神经血管瘤(11.1%)。病程中表现为面瘫23例(85.2%);听力下降和耳鸣各11例(40.7%);表现为耳下肿块,且有耳痛、眩晕、耳闷、面部麻木、抽搐5例(18.5%)。24例(88.9%)CT或MRI提示为面神经来源肿瘤。24例(88.9%)累及2个或2个以上的面神经节段,其中累及乳突段处占87.5%(21/24),累及鼓室段处占70.8%(17/24),累及膝状神经节处占62.5%(15/24),累及内耳道占4.2%(1/24);只累及面神经的1个节段占11.1%(3/27)。27例均手术完整切除肿瘤,其中13例进行了同期面神经重建术,包括11例腓肠神经移植术,1例面-舌下神经吻合术,1例面神经端端吻合术。2例在切除肿瘤的同时保留了面神经解剖结构的完整性。结论:面神经瘤是一种较少见的良行肿瘤,临床症状多样,CT、MRI等影像学检...     

Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy

OBJECTIVES/HYPOTHESIS: To assess whether the use of continuous intraoperative facial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy. STUDY DESIGN: A retrospective analysis. METHODS: Forty-five consecutive parotidectomies were performed using an electromyograph (EMG)-based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice. RESULTS: The overall incidence of facial paralysis (House-Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (chi, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (chi and Fisher's, P < .05). CONCLUSIONS: The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.