听神经瘤枕下乙状窦后入路显微切除术后面神经功能损伤的危险因素分析

Risk factors for facial nerve function impairment following microsurgical resection of acoustic neuroma via suboccipital retrosigmoid approach

目的研究听神经瘤(AN)显微镜外科切除后面神经功能损伤的危险因素。方法回顾性分析绵阳市中心医院神经外科自2017年1月至2020年1月行枕下乙状窦后入路显微切除术治疗的140例AN患者的临床资料,随访6个月,采用H-B面神经功能受损量表(HBFGS)评估患者术后6个月的面神经受损程度,并将年龄、性别、肿瘤直径、肿瘤切除范围、手术时间、术中是否行面神经监测、面神经位置、面神经与肿瘤的黏连严重程度等作为分析因素,分析影响患者术后面神经功能受损的独立危险因素。结果按照术后6个月面神经HBFGS分级结果将患者分为2组,HBFGS分级Ⅰ~Ⅲ级为轻中度障碍组(78例),Ⅳ~Ⅵ级为重度障碍组(62例)。轻中度障碍组患者的肿瘤最大直径显著小于重度障碍组,手术时间显著短于重度障碍组,差异均具有统计学意义(P<0.05);肿瘤切除程度、术中行面神经监测情况以及面神经与肿瘤的黏连程度与重度障碍组比较,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,肿瘤最大直径>3.13 cm、肿瘤部分切除与次全切除、面神经与肿瘤中、重度黏连均是导致术后面神经功能严重障碍的独立危险因素(OR>1,P<0.05),而术中行面神经监测是术后面神经严重障碍的保护因素(OR<1,P<0.05)。结论AN瘤体大小、肿瘤切除程度、术中是否行面神经监测以及面神经与肿瘤的黏连程度是影响患者乙状窦后入路显微切除AN术后面神经功能受损程度的独立因素。

Objective To investigate the risk factors for facial nerve function impairment following microsurgical resection of acoustic neuroma(AN)via suboccipital retrosigmoid approach.Methods The clinical data of 140 AN patients receiving microsurgical resection via suboccipital retrosigmoid approach in Neurosurgery Department of Mianyang City Central Hospital from January 2017 to January 2020 were retrospectively analyzed.All patients were followed up for 6 months.The degree of facial nerve damage of patients was assessed using H-B facial nerve grading system(HBFGS).The age,gender,tumor diameter,tumor resection range,operative time,intraoperative facial nerve monitoring,facial nerve location and the adhesion between the facial nerve and tumor capsule and other factors were taken as analysis factors.Logistic regression was used to analyze the independent risk factors affecting postoperative facial nerve function impairment.Results The patients were divided into two groups according to the HBFGS scale of facial nerve 6 months after operation.HBFGS gradeⅠ-Ⅲwas mild-to-moderate disorder group(78 cases),and HBFGS gradeⅣ-Ⅵwas severe disorder group(62 cases).Univariate analysis showed that mild-to-moderate disorder group had lower maximum tumor diameter and shorter operation time than those of severe disorder group(P<0.05),moreover,tumor resection rang,intraoperative facial nerve monitoring,and the adhesion between the facial nerve and tumor capsule also showed significant difference between two groups(P<0.05).Logistic multivariate regression analysis showed that the maximum tumor diameter>3.13 cm,partial resection and subtotal resection of the tumor and moderate and severe adhesion between the facial nerve and tumor capsule were independent risk factors affecting postoperative facial nerve impairment(OR>1,P<0.05),and intraoperative facial nerve monitoring was a protective factor for severe postoperative facial nerve impairment(OR<1,P<0.05).Conclusion The tumor diameter,tumor resection range,intraoperative facial nerve monitoring and the severity of the adhesion between the facial nerve and tumor capsule are independent factors affecting facial nerve function impairment following microsurgical resection of AN via suboccipital retrosigmoid approach.