舌下神经-面神经侧-端吻合术治疗听神经瘤术后重度周围性面瘫的效果分析

Effect analysis of hypoglossal-facial nerve side-to-end neurorrhaphy for severe peripheral facial paralysis afteracoustic neuromaoperation

目的探讨舌下神经-面神经侧-端吻合术治疗听神经瘤术后重度周围性面瘫的手术疗效及神经电生理检测相关指标的变化.方法回顾性分析2018年2月至2020年12月首都医科大学北京天坛医院神经外科收治的35例听神经瘤术后重度周围性面瘫患者的临床资料.术前共24例行面神经电生理检测.所有患者均行舌下神经-面神经侧-端吻合术.术前、术后6个月及12个月采用面神经功能House-Brackmann(H-B)分级、Sunnybrook面神经评定量表(Sunnybrook评分)、面神经电生理检测(包括瞬目反射、面神经电图、纤颤电位及正锐波、运动单位电位)综合评估患者的面神经功能.结果35例患者术后6个月随访时,29例(82.9%)患者的静态面容和表情较术前明显改善,H-B分级及Sunnybrook评分较术前均有明显改善(均P<0.001);术后12个月,H-B分级及Sunnybrook评分较术后6个月均有明显改善(均P<0.001).术后共23例行神经电生理检测随访(1例失访),患者术前、术后6个月均未检测到同侧瞬目反射R1、R2波,术后12个月瞬目反射的引出比例较术前明显增多(P<0.001).与术前比较,术后6个月及12个月的面神经电图波幅均明显升高、纤颤电位及正锐波分级均明显下降(均P<0.05);术后12个月,口轮匝肌、眼轮匝肌的运动单位电位波幅较术前均明显升高(均P<0.05).结论舌下神经-面神经侧-端吻合术可有效促进听神经瘤术后重度周围性面瘫的恢复,其中以口轮匝肌及眼轮匝肌改善最显著.

ObjectiveTo investigate the surgical effect of hypoglossal-facial nerve side-to-end neurorrhaphy in the treatment of severe peripheral facial paralysis after acoustic neuroma and the changes of related electrophysiological indicators.MethodsThe clinical data of 35 patients with severe peripheral facial paralysis after acoustic neuroma surgery who were admitted to the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from February 2018 to December 2020 were retrospectively analyzed.A total of 24 cases of facial nerve electrophysiological examination were performed before operation.Hypoglossal nerve-facial nerve side-to-end neurorrhaphy was performed in all patients.House-Brackmann(H-B)facial nerve function grading,Sunnybrook facial nerve rating scale(Sunnybrook score),facial nerve electrophysiological exams(including blink reflex,facial nerve electrogram,fibrillation potential,positive sharp wave,motor unit potential)were used before surgery,6 months and 12 months after surgery to comprehensively evaluate the facial nerve function of patients.ResultsAfter 6 months of fllow-up,29(82.9%)patients'static face and expression were significantly recovered.H-B grade and Sunnybrook score were significantly improved compared with those prior to operation(both P<0.001).At 12 months after operation,H-B grade and Sunnybrook score were significantly improved compared with those at 6 months after operation(both P<0.001)A total of 23 patients underwent electrophysiological follow-up(1 case was lost to follow-up).No ipsilateral R1 or R2 wave was detected before operation and 6 months after operation,and the proportion of blink reflex elicited at 12 months after operation was significantly increased compared with that before operation(P<0.001).The amplitude of facial electrogram at 6 months and 12 months post operation was significantly increased,and the fibrillation potential and positive sharp wave grade were significantly decreased(all P<0.05).At 12months post operation,the motor unit potential amplitude of orbicularis oris muscle and orbicularis oculi muscle were significantly higher than those before operation(both P<0.05).ConclusionsThe hypoglossal-facial nerve side-to-end neurorrhaphy can effectively promote the recovery of severe peripheral facial paralysis after acoustic neuroma surgery,among which the orbicularis oris and orbicularis oculi muscles have the most significant improvement.