听神经瘤术后面神经功能恢复规律及肿瘤大小对其的影响

The facial nerve functional recovery law and tumor size impact after acoustic neuroma surgery

目的探讨听神经瘤术后面神经功能恢复的规律以及肿瘤大小对术后面神经功能的影响。方法 89例听神经瘤患者均采用显微外科乙状窦后入路开颅听神经瘤切除术,术中行神经电生理检测,均达到面神经的完整解剖保留。于术后即刻、术后15 d、45 d、3个月、6个月、12个月及12个月后等不同时点采用面神经功能分级标准（HB分级）对患者的面神经功能级别进行评估,分析术后面神经功能的恢复规律。并根据瘤体最大直径分为〈30 mm（23例）、30~40 mm（31例）和≥40 mm组（35例）,比较各组术后早期（15 d）和远期（12个月后）的面神经功能分级。结果本组89例患者,听神经瘤术后15 d面神经功能最差（优秀率为52.81%）,3个月内逐渐恢复（优秀率为80.90%）,12个月内绝大部分可恢复至优秀水平（优秀率为91.01%）,12个月后面神经恢复较平稳（优秀率为92.13%）。不同瘤体直径组术后早、远期HB分级差异均有统计学意义（χ~2分别为23.34、14.46,P〈0.05）;瘤体直径与术后早、远期HB分级均呈正相关（r分别为0.476、0.379,P〈0.05）,面神经功能优秀率均随瘤体直径增加而降低。结论听神经瘤术后早期（15 d内）患者面神经功能可能出现明显恶化,术后12个月绝大部分可恢复至优秀水平。瘤体直径是影响术后早、远期面神经功能预后的因素之一。

Objective To explore the facial nerve functional recovery law after resection of acoustic neuroma,and theinfluence of tumor size on postoperative facial nerve function. Methods According to the House-Brackman（HB） facialnerve function classification method, 89 patients with acoustic neuroma were performed microsurgical resection with the ret-rosigmoid approach and facial nerve preservation. The HB classification method was used to evaluate the facial nerve func-tion at operation, 15 d, 45 d, 3 m, 6 m, 12 m and more than 12 m after surgery. The recovery pattern of neurological functionafter operation was analyzed. al. According to the tumor size, patients were divided into three groups： diameter 30 mmgroup（n=23）, 30-40 mm group（n=31） and ≥40 mm group（n=35）. The facial nerve function was compared between differentgroups with early postoperative（within 15 days） and long-term（more than 12 months）. Results The facial nerve functionwas the worst in 15 days after operation（excellence rate was 52.81%）, but the function was returned to normal in postopera-tive 3 months（excellent rate reached 80.90%）. After postoperative 12 months, almost all patients returned to normal func-tion（excellent rate was 91.01%）, and the facial nerve recovery was more smoothly（excellent rate was 92.13%）. Tumor sizehad remarkable effect on facial nerve function in the early postoperative period（χ~2= 23.34, P〈0.05）, and long-term period（χ~2= 14.46, P〈0.05）. And tumor size was positively correlated with classification of facial nerve function in the early stage（r = 0.476, P〈0.05） and long-term stage（r = 0.379, P〈0.05）. The excellent rates of postoperative facial nerve functionwere decreased with the increased diameters of tumor size. Conclusion The facial nerve function may appear deteriorationin early postoperative period（within 15 days） in patients with acoustic neuroma, which can return to the normal level in 12 months. The diameter of tumor is one of important factors influencing the early and long-term prognosis of postoperative fa-cial nerve function.