面神经F波对听神经瘤术后面瘫的预测价值

Predictive value of facial nerve F wave in facial paralysis after acoustic neuroma surgery

目的探讨听神经瘤患者术前面神经F波对术后面瘫的预测价值。方法回顾性分析2016年1月至2017年1月首都医科大学附属北京天坛医院神经外科收治的37例术前无面瘫的单侧小脑脑桥角区听神经瘤患者,并于术前测定健侧和患侧的面神经F波潜伏期参数;术后12个月进行随访,采用House-Brackmann面神经功能分级方法(简称H-B分级)评估面神经的功能,将III ~VI级归为术后面瘫组(8例),将I级归为术后无面瘫组(29例),并比较两组术前的F波潜伏期、F?M波潜伏期、F波侧间差、F?M波侧间差值。绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),以评价术前面神经F波对术后面瘫的预测价值。结果术前患侧F波潜伏期、F?M波潜伏期均较健侧延长(均P <0.05)。面瘫组较无面瘫组的术前患侧F波潜伏期、F-M波潜伏期延长(均P<0.05);面瘫组的术前F波侧间差、F-M波侧间差大于无面瘫组(均PvO.05)。术前患侧F波潜伏期、F?M波潜伏期、患侧F波侧间差及F-M波侧间差可用于预测术后患者的面神经H?B分级(AUC分别为0.813、0. 920、0.793、0. 996,均P<0. 05)。结论听神经瘤患者术前面神经F波潜伏期、F-M波的潜伏期和侧间差对术后面瘫风险具有预测价值。

Objective To investigate the predictive value of preoperative facial nerve F wave in postoperative facial paralysis following acoustic neuroma surgery. Methods A retrospective analysis was conducted on 37 patients with unilateral cerebellopontine angle acoustic neuroma without facial paralysis admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2016 to January 2017. The latency parameters of facial nerve F wave in healthy and affected sides were measured before operation. Facial nerve function was evaluated based on the House-Brackmann ( H-B) grading system at 12 months post surgery. Patients with Grade DI - VI were categorized into postoperative facial paralysis group (8 cases) and those with Grade I was classified as postoperative non-facial paralysis group (29 cases). The preoperative F wave latency, F-M wave latency, F wave side-to?side difference, and F-M wave side-to-side difference were compared between the 2 groups. The operating characteristic curve (ROC) was plotted and the area under the curve ( AUC) was calculated to evaluate the predictive value of F wave of facial nerve before operation in postoperative facial paralysis. Results The latency of F wave and F-M wave on the affected side was longer than that on the affected side ( both P <0. 05). The latencies of F wave and F-M wave on the affected side in the facial paralysis group were longer than that in the non-facial paralysis group ( both P <0. 05 ), and the latencies of F wave and F-M wave side-to-side difference in the facial paralysis group were larger than those in the non-facial paralysis group ( both P < 0. 05 ). The preoperative F-wave latency, F-M wave latency, F-wave latency side-to-side difference and F-M wave latency side-to-side difference could be used to predict the H-B grade of facial nerve after operation ( AUC: 0. 813 , 0.920, 0. 793 and 0. 996, respectively, all P < 0. 05 ). Conclusion The latency and latency side-to-side difference of F wave and F-M wave of preoperative facial nerve in patients with acoustic neuroma seem to be able to predict the risk of postoperative facial paralysis.