前庭神经鞘瘤术后面神经功能损伤影响因素分析

Multivariate analysis of factors influencing postoperative facial nerve function after vestibular schwannoma surgery

目的筛查前庭神经鞘瘤术后面神经功能损伤的相关危险因素。方法共纳入2018年12月至2020年1月95例前庭神经鞘瘤患者,均行经乙状窦后入路手术,术前MRI记录肿瘤直径和分类、肿瘤体积和体表面积、肿瘤性质,术中观察面神经走行、肿瘤与面神经粘连程度、肿瘤切除程度和面神经功能情况,术后8 d评价面神经功能。单因素和多因素Logistic回归分析筛查面神经功能损伤的相关危险因素。结果95例患者中肿瘤全切除80例(84.21%),其中3例面神经未解剖保留;近全切除15例(15.79%),其中14例面神经残留少量薄层肿瘤、1例脑干残留少量薄层肿瘤且面神经未解剖保留。Logistic回归分析显示,肿瘤与面神经重度粘连是面神经功能损伤的危险因素(OR=22.349,95%CI:1.895~263.599;P=0.014)。结论对于与面神经重度粘连的前庭神经鞘瘤,手术应更加仔细,若肿瘤全切除和保留面神经功能困难,建议在肿瘤与面神经粘连最紧密处残留薄层肿瘤以保留面神经功能。

Objective To investigate the risk factors of vestibular schwannoma without facial nerve functional preservation.Methods Total 95 patients with vestibular schwannoma who underwent surgery via the sigmoid sinus approach bewteen December 2018 to January 2020 were included.Tumor diameter and classification,tumor volume and surface area,tumor property were recorded according to MRI.The course of facial nerve,adhesion degree between tumor and facial nerve,extent of tumor resection and facial nerve anatomic preservation were recorded according to intraoperative observation.Facial nerve function after 8 d was evaluated.Univariate and multivariate Logistic regression analyses were performed to analyze risk factors associated without facial nerve functional preservation.Results Of the 95 patients,80 patients(84.21%)underwent gross total resection,among which 3 patients had no anatomical preservation of facial nerve.15 patients(15.79%)underwent near total resection,including 14 cases with thin layer of tumor remaining on the facial nerve,and one case with thin layer of tumor remaining on the brainstem and no anatomical preservation of facial nerve.Logistic regression analysis showed that severe adhesion between tumor and facial nerve was risk factor for functional impairment of facial nerve(OR=22.349,95%CI:1.895-263.599;P=0.014).Conclusions For severe adhesion,the operation should be more careful.If the tumor might not be completely removed under the premise of preserving the facial nerve function,a small amount of tumor could be left on the facial nerve.