听神经瘤术后影响面神经功能的相关因素分析

Analysis of factors related to the impact on facial nerve function after acoustic neuroma surgery

目的探讨显微镜下经乙状窦后入路听神经瘤术后短期及中晚期面神经功能预后的相关因素。方法分析自2018年8月至2022年7月徐州医科大学附属医院神经外科收治的120例听神经瘤患者的临床资料,采用House-Brackmann(HB)分级评价听神经瘤患者术后2周及6个月的面神经功能,分为预后良好组与预后不良组,运用Logistic单因素与多因素回归分析筛选出相关危险因素并进行分析。结果术后肿瘤全切91例,全切率达75.8%,术后并发症发生率达23.3%。术后2周,50例(43.1%)患者面神经功能预后良好,70例(58.3%)患者面神经功能预后不良;术后6个月,84例(70.0%)患者面神经功能预后良好,36例(30.0%)患者面神经功能预后不良。单因素分析结果显示术后2周,两组的肿瘤直径、症状持续时间、与面神经黏连程度、是否磨除内听道壁具有统计学意义(P<0.05)。术后6个月,两组的肿瘤直径、症状持续时间、瘤周水肿、肿瘤质地具有统计学意义(P<0.05)。多因素分析显示肿瘤直径、与面神经黏连程度是术后2周面神经功能预后不良的独立危险因素(P<0.05),肿瘤直径、症状持续时间是术后6个月面神经功能预后不良的独立危险因素(P<0.05)。结论肿瘤直径越大、肿瘤与面神经黏连越紧密,患者术后2周的面神经功能预后越差;肿瘤直径越大、术前临床症状持续时间越长,患者术后6个月的面神经功能预后越差。

Objective To explore the relevant factors that affect the short-term and mid-to-late-term prognosis of facial nerve function after microsurgery via the retrosigmoid approach for acoustic neuroma.Methods The clinical data of 120 patients with acoustic neuroma admitted to the Department of Neurosurgery of the Affiliated Hospital of Xuzhou Medical University from August 2018 to July 2022 were retrospectively analyzed.The facial nerve function of the patients with acoustic neuroma 2 weeks and 6 months after surgery was evaluated by House Brackmann(HB)grading,and they were divided into a good-prognosis group and a poor-prognosis group.Logistic single-factor and multiple-factor regression analyses were used to screen out the relevant risk factors and analyze the relationship between them and the prognosis of the facial nerve.Results Total resection was performed in 91 cases,with a resection rate of 75.8%.The post-operation complication rate was 23.3%.Two weeks after surgery,50 patients(43.1%)had a good facial nerve function prognosis,and 70 patients(58.3%)had a poor facial nerve function prognosis.Six months after surgery,84 patients(70.0%)had a good facial nerve function prognosis,and 36 patients(30.0%)had a poor facial nerve function prognosis.The results of the univariate analysis showed that at 2 weeks postoperatively,the tumor diameter,duration of symptoms,degree of adhesion to the facial nerve,and whether or not the wall of the internal auditory canal was abraded were statistically significant in both groups(P<0.05).At 6 months postoperatively,tumor diameter,duration of symptoms,peritumoral edema,and tumor texture were statistically significant in both groups(P<0.05).Multifactorial analysis showed that tumor diameter and degree of adhesion to the facial nerve were independent risk factors for poor prognosis of facial nerve function at 2 weeks postoperatively(P<0.05),and tumor diameter and duration of symptoms were independent risk factors for poor prognosis of facial nerve function at 6 months postoperatively(P<0.05).Conclusions The larger the tumor diameter and closer adhesion between the tumor and the facial nerve,the worse the prognosis of facial nerve function 2 weeks after surgery.The larger the tumor diameter and the longer the duration of preoperative clinical symptoms,the worse the prognosis of facial nerve function 6 months after surgery.