Relative Factors Analysis Of Affecting Facial Nerve Function Retention After Operation Of Acoustic Neuroma

Objective: To investigate the related factors affecting facial nerve function retention after microsurgical resection of acoustic neuroma via suboccipital retrosigmoid sinus approach,so as to provide certain theoretical support for surgeons to perform preoperative evaluation according to the objective conditions of patients and better protect facial nerve function after surgery.Methods:This study retrospectively analyzed the clinical data of 52 patients with acoustic neuroma that were admitted to the department of neurosurgery,the first affiliated hospital of Dalian medical university from March 2015 to September 2019.All cases included in the study were resected microscopically through the suboccipital retrosigmoid sinus approach,and were confirmed as acoustic neuroma by postoperative pathological examination.Postoperative follow-up varied from 3 months to 49 months,and the facial nerve function of all patients was evaluated by house-brackmann facial nerve function grading criteria.SPSS21 statistical software was used to conduct univariate analysis on gender,age,tumor resection degree,tumor site,preoperative course of disease,tumor cystic change,intraoperative facial nerve monitoring and tumor size,and Logistic regression analysis was performed on the factors with statistical significance.P < 0.05 was considered statistically significant.Results: According to the inclusion and exclusion standard,a total of 52 patients with acoustic neuroma were included in this study.There were 23 males(44.2%)and 29females(55.8%),with a male-female ratio of 0.793 to 1.The youngest was 24 years,the oldest was 72 years,and the mean age was 54.5±10.7 years.The shortest course of disease was 2 months and the longest was 15 years,with an average of 43.0±45.1months.There were 31 patients(59.6%)with tumors on the left side and 21 patients(40.4%)with tumors on the right side,without bilateral acoustic neuroma.There were 28patients(53.8%)with no cystic change and 24 patients(46.2%)with cystic change.The maximum diameter of the tumor was 1.2cm-5.9cm,and the average maximum diameter was 3.0±0.97 cm.During the operation,there were 31 cases(59.6%)of facial nerve monitoring,21 cases(40.4%)of no facial nerve monitoring,a total of 42 cases(80.8%)were completely cut,10 cases(19.2%)were not completely cut,and all facial nerves were anatomical reservation.Postoperative follow-up ranged from 3 months to 49 months.The classification of facial nerve function was as follows: 12 cases of H-B I grade,16 cases of H-B II grade,12 cases of H-B III grade,10 cases of H-B IV grade,2cases of H-B V grade,and 0 cases of H-B VI grade.Univariate analysis showed that disease course(P=0.046),tumor size(P=0.001),intraoperative facial nerve monitoring(P=0.038)were related to facial nerve function after acoustic neuroma.The results of multivariate Logistic regression analysis showed that tumor size(P=0.035)and intraoperative facial nerve monitoring(P=0.036)had statistical significance and were independent correlated factors affecting postoperative facial nerve function retention.Conclusion:1.On the premise of familiar with the pathological anatomical features of acoustic neuroma before surgery,microresection of acoustic neuroma through suboccipital retrosigmoid sinus approach combined with intraoperative electrophysiological monitoring of facial nerve can improve the total tumor resection rate,facial nerve anatomy and functional retention rate.2.The study confirmed that the size of acoustic neuroma and whether to performintraoperative electrophysiological monitoring of facial nerve can be independently used as factors affecting postoperative facial nerve function retention.The larger the maximum diameter of acoustic neuroma,the worse the function of facial nerve after operation.However,intraoperative electrophysiological monitoring of facial nerve can better protect the function of facial nerve.Other factors such as gender,age,preoperative course of disease,degree of tumor resection,tumor site,and tumor cystic change were not independent factors influencing facial nerve function retention after surgery.3.Microsurgical treatment is the main treatment of acoustic neuroma.The surgeon should evaluate the patient's condition scientifically objectively and multidisciplinary collaboration to develop individualized treatment plans,before the operation according to the patient's age,occupation,physical condition,tumor size and the patient's expectation after the operation.