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

doi:10.3969/j.issn.1672-6731.2021.07.010

Abstract

Abstract:

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.

Key words: Neurilemmoma, Vestibular nerve, Facial nerve injuries, Microsurgery, Risk factors, Logistic models

摘要：

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。

关键词: 神经鞘瘤, 前庭神经, 面神经损伤, 显微外科手术, 危险因素, Logistic模型

SONG Gang, WU Xiao-long, WANG Xu, LI Ming-chu, GUO Hong-chuan, XIAO Xin-ru, CHEN Ge, BAO Yu-hai, LIANG Jian-tao. Multivariate analysis of factors influencing postoperative facial nerve function after vestibular schwannoma surgery[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(7): 586-591.

宋刚, 吴晓龙, 王旭, 李茗初, 郭宏川, 肖新如, 陈革, 鲍遇海, 梁建涛. 前庭神经鞘瘤术后面神经功能损伤影响因素分析[J]. 中国现代神经疾病杂志, 2021, 21(7): 586-591.

/ / Recommend / Download Citations

URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2021.07.010

http://journal11.magtechjournal.com/cjcnn/EN/Y2021/V21/I7/586

References

[1] Breshears JD, Morshed RA, Molinaro AM, McDermott MW, Cheung SW, Theodosopoulos PV. Residual tumor volume and location predict progression after primary subtotal resection of sporadic vestibular schwannomas:a retrospective volumetric study[J]. Neurosurgery, 2020, 86:410-416.
[2] Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas[J]. J Neurosurg, 2010, 112:860-867.
[3] Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients[J]. J Neurosurg, 2006, 105:527-535.
[4] Bae CW, Cho YH, Hong SH, Kim JH, Lee JK, Kim CJ. The anatomical location and course of the facial nerve in vestibular schwannomas:a study of 163 surgically treated cases[J]. J Korean Neurosurg Soc, 2007, 42:450-454.
[5] House JW, Brackmann DE. Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93:146-147.
[6] Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas):the facial nerve:preservation and restitution of function[J]. Neurosurgery, 1997, 40:684-694.
[7] Kunert P, Dziedzic T, Podgorska A, Nowak A, Czernicki T, Marchel A. Surgery for sporadic vestibular schwannoma:Part Ⅳ:predictive factors influencing facial nerve function after surgery[J]. Neurol Neurochir Pol, 2016, 50:36-44.
[8] Leong SC, Lesser TH. A national survey of facial paralysis on the quality of life of patients with acoustic neuroma[J]. Otol Neurotol, 2015, 36:503-509.
[9] Chen Z, Prasad SC, Di Lella F, Medina M, Piccirillo E, Taibah A, Russo A, Yin S, Sanna M. The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas[J]. J Neurosurg, 2014, 120:1278-1287.
[10] Freeman SR, Ramsden RT, Saeed SR, Alzoubi FQ, Simo R, Rutherford SA, King AT. Revision surgery for residual or recurrent vestibular schwannoma[J]. Otol Neurotol, 2007, 28:1076-1082.
[11] Sasaki T, Shono T, Hashiguchi K, Yoshida F, Suzuki SO. Histological considerations of the cleavage plane for preservation of facial and cochlear nerve functions in vestibular schwannoma surgery[J]. J Neurosurg, 2009, 110:648-655.
[12] Zaouche S, Ionescu E, Dubreuil C, Ferber-Viart C. Pre-and intraoperative predictive factors of facial palsy in vestibular schwannoma surgery[J]. Acta Otolaryngol, 2005, 125:363-369.
[13] Sughrue ME, Yang I, Rutkowski MJ, Aranda D, Parsa AT. Preservation of facial nerve function after resection of vestibular schwannoma[J]. Br J Neurosurg, 2010, 24:666-671.
[14] Wiet RJ, Mamikoglu B, Odom L, Hoistad DL. Long-term results of the first 500 cases of acoustic neuroma surgery[J]. Otolaryngol Head Neck Surg, 2001, 124:645-651.
[15] Mamikoglu B, Wiet RJ, Esquivel CR. Translabyrinthine approach for the management of large and giant vestibular schwannomas[J]. Otol Neurotol, 2002, 23:224-227.
[16] Sluyter S, Graamans K, Tulleken CA, Van Veelen CW. Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach[J]. J Neurosurg, 2001, 94:61-66.
[17] Staecker H, Nadol JB Jr, Ojeman R, Ronner S, McKenna MJ. Hearing preservation in acoustic neuroma surgery:middle fossa versus retrosigmoid approach[J]. Am J Otol, 2000, 21:399-404.
[18] Yamakami I, Uchino Y, Kobayashi E, Yamaura A, Oka N. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity[J]. J Neurol Neurosurg Psychiatry, 2004, 75:453-458.
[19] Seo JH, Jun BC, Jeon EJ, Chang KH. Predictive factors influencing facial nerve outcomes in surgery for small-sized vestibular schwannoma[J]. Acta Otolaryngol, 2013, 133:722-727.
[20] Esquia-Medina GN, Grayeli AB, Ferrary E, Tubach F, Bernat I, Zhang Z, Bianchi C, Kalamarides M, Sterkers O. Do facial nerve displacement pattern and tumor adhesion influence the facial nerve outcome in vestibular schwannoma surgery[J]? Otol Neurotol, 2009, 30:392-397.
[21] McElveen JT Jr, Belmonte RG, Fukushima T, Bullard DE. A review of facial nerve outcome in 100 consecutive cases of acoustic tumor surgery[J]. Laryngoscope, 2000, 110(10 Pt 1):1667-1672.
[22] Mastronardi L, Cacciotti G, Roperto R, Di Scipio E, Tonelli MP, Carpineta E. Position and course of facial nerve and postoperative facial nerve results in vestibular schwannoma microsurgery[J]. World Neurosurg, 2016, 94:174-180.
[23] Torres R, Nguyen Y, Vanier A, Smail M, Ferrary E, Sterkers O, Kalamarides M, Bernardeschi D. Multivariate analysis of factors influencing facial nerve outcome following microsurgical resection of vestibular schwannoma[J]. Otolaryngol Head Neck Surg, 2017, 156:525-533.
[24] Troude L, Boucekine M, Montava M, Lavieille JP, Regis JM, Roche PH. Predictive factors of early postoperative and long-term facial nerve function after large vestibular schwannoma surgery[J]. World Neurosurg, 2019, 127:599-608.
[25] Fundova P, Charabi S, Tos M, Thomsen J. Cystic vestibular schwannoma:surgical outcome[J]. J Laryngol Otol, 2000, 114:935-939.
[26] Yashar P, Zada G, Harris B, Giannotta SL. Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas:surgical experience over a decade and review of the literature[J]. Neurosurg Focus, 2012, 33:E13.

Please choose a citation manager

Content to export