显微切除大型听神经瘤术后面神经功能影响因素

Influence factors analysis of facial nerve function after the microsurgical removal of large acoustic neuromas

摘要:

目的 分析在面神经功能监护下切除大型听神经瘤术后面神经功能保留的影响因素。方法 对2002年1月至2008年4月湘雅医院神经外科在面肌肌电图监测下经乙状窦后入路显微切除的127例大型听神经瘤手术进行回顾性研究。采用门诊复查和电话随访的方式参照House-Brackmann分级系统评价面神经功能。 结果 总计127例听神经瘤患者，大型肿瘤（≥30 mm）占92.1%（116/126）。肿瘤全切除率为98.4%（125/127），面神经解剖保留率为99.2%（126/127），死亡率为2.36%（3/127）。术后即刻的优秀面神经功能（H-B Ⅰ-Ⅱ级）保留率为90.2%（111/123），随访1年及以上的优秀面神经功能保留率为85.5%（71/83）。结论 听神经瘤患者术后远期面神经功能与术者娴熟的显微神经外科技术密切相关，与术后早期面神经功能、肿瘤大小呈正相关，与患者年龄、是否合并脑积水、囊性变、症状持续时间未见相关关系。

Abstract:

Objective To study facial function after large acoustic neruomas resections and identify factors which influence these outcomes.Methods A total of 127 cases acoustic neuromas were microsurgically removed via retrosigmoid approach using electromyo-graphy monitoring at neurosurgical department of Xiangya hospital from 2002.1-2008.4. by the senior surgeon (professor Yuan xianrui, MD & PHD). A retro-spectively reviewed was performed. Outpatient clinical follow-up every 3 months includes evaluation of facial nerve function. The facial nerve function was assessed using House-Brackmann facial nerve grading system.Results Of 125 cases of complete removal and 2 cases of deliberately partial removal, the facial nerve was anatomically preserved in 126 of 127 cases (99.2%) and preservation is supported by special electrophysiological monitoring. The non-parameter analysis and test for linear trend showed that tumor size (P<0.005) and early facial nerve function (P<0.0001) correlated with the facial nerve function at 1 year or more postoperatively. Patient age, symptom duration、cystic change, and preoperative hydrocephalus did not influence facial nerve function.Conclusions Resection of acoustic neuroma via retrosigmoid approach using electromyography monitoring is a safe and effective method. The long-term facial nerve function correlates with early facial nerve function (P<0.0001) and tumor size (P<0.005).