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.

Surgery Effects in a Cohort of 42 Patients Received Facial SchwannomaResection and Facial Nerve Reconstruction Simultaneously

Objective To evaluate the effects of facial nerve reconstruction surgery by reviewing the clinical information and follow-up results of 42 cases.Methods The clinical data of 42 patients who were diagnosed as facial schwannoma and received tumor resection and facial nerve reconstruction simultaneously from January 2004 to December 2015 in our department were studied.The surgeries included anastomosis between the two faical nerves(3 cases), facial nerve transplantation(4 cases), Hypoglossal/masseteric-facial nerve anastomosis(27 cases) and cross-facial nerve graft(8 cases).We evaluated the facial nerve function using H-B grade and Fisch score post-operation (1 week, 3 months,6 months and 1 year after surgery).Results The Fisch scores were significantly different between 1 week and 3 months, 3 months and 6 months post-operation for patients received cross-facial nerve graft.The facial nerve function became better as time went by.While there were no difference between 6 months and 1 year post-operation.On the other hand, the scores were significantly different between 6 months and 1 year post-operation for patients received hypoglossal/masseteric facial nerve anastomosis.Conclusion Most patients received tumor section and facial nerve reconstruction simultaneously could gain good results, it took a long time for the facial nerve function to return to a stable state and some of them were still in recovering 1 year after surgery.