Exploring Risk Factors For The Facial Nerve Outcomes After The Vestibular Schwannoma Resection And Identification Of Pathogenesis In NF2

Vestibular schwannomas(VSs)is a common benign tumor in the brain,accounting for approximately 6%-8%of all intracranial tumors,and 80%of tumors in the cerebellopontine angle region.The disease occurs in middle-aged and elderly people,with an average age of about 50 years old.The incidence of both sides is basically the same,most of which are unilateral.Although the tumor is benign tumor,it poses no less threat to the patient’s life and health than malignant tumors.This is because the tumor growth location is located in the inner auditory canal,the cerebellopontine angle area,and the surrounding vascular nerves,brainstems,and cerebellar tissues are densely packed,making the tumor growth very easy to compress the surrounding tissues to produce neurological damage and other symptoms.Narrow space,the increase in tumor volume is more likely to cause cranial hypertension,and in severe cases can even cause hernia to endanger patients’ lives.Because of this,the treatment of vestibular schwannoma has become a problem.Vestibular schwannomas are treated in a variety of ways,including stereotactic radiation therapy,surgical treatment,and follow-up.Among them,surgical treatment is still the main treatment.Surgical treatment has made great progress in the past few decades,and the postoperative mortality rate has been greatly reduced.However,the possibility of facial nerve function injury in patients after surgery is still large,and the injury of facial nerve function will make patients have a higher quality of life The decline is a problem that all doctors have to face.Therefore,during the surgical treatment of vestibular schwannoma,the protection of facial nerve function is very important.In order to improve the retention rate of facial nerve function after surgery,we must first determine the factors that cause facial nerve function damage.The first part of this study focuses on this,and analyzes the factors of facial nerve function damage and the surgical procedures of 7 days after vestibular schwannoma through multifactor analysis Factors of Facial Nerve Function Recovery After 6 Months(Part 1).Vestibular schwannomas are mostly unilateral,but there are still a few that are bilateral.We call it bilateral neurofibromatosis type 2(NF2),which is an autosomal dominant hereditary disease caused by mutations in the NF2 gene.NF2 patients can be accompanied by other tumors,such as gliomas and meningiomas.NF2 gene is a tumor suppressor gene,located on 22q12 on the autosome,and its encoded protein is merlin protein.The biological role of this protein has been studied in detail in the past.Previous studies have shown that Merlin protein inactivation is a common pathogenesis of vestibular schwannoma,NF2 and related tumors.In addition,Merlin protein inactivation can cause cell growth,growth,and metabolic pathway disorders.However,not all schwannomas have mutations in the NF2 gene,suggesting that other mechanisms may be involved in tumorigenesis and development.With the advancement of gene sequencing and analysis technology,the research on tumorcausing genes and its mechanisms has not been limited to traditional experiments.Therefore,this study explores the pathogenesis of NF2 through genome sequencing analysis technology,hoping to find genes related to the pathogenesis of NF2 and abnormal expression signal pathways,so as to provide new ideas for future treatment of NF2(Part 2).PART1 Analysis of Facial Nerve Function Injury and Recovery Factors after Vestibular Schwannoma SurgeryObject To analyze risk factors affecting the facial nerve functional outcomes in patients receiving vestibular schwannoma surgery.Method A total of 62 cases receiving vestibular schwannoma surgery via retrosigmoid sinus approach were analyzed retrospectively.The facial nerve functional outcomes of all enrolled patients were evaluated 6 months after the operation according to HouseBrackmann grading scale.The relationships between facial nerve injury and its potential risk factors were analyzed.Results Postoperative facial nerve injury was found in 36 patients(58.1%)7 days after the operation.Postoperative facial nerve injury was found in 19 patients(30.6%)6 months after the operation.The results of univariate logistic regression analysis indicated that the tumor volume,the facial nerve elongation,the enlargement of internal auditory canal(IAC),and the facial nerve adhesion to tumor were significantly correlated with the occurrence of facial nerve injury 7 days after the operation,there is no risk factors were found with the facial nerve function recovery at 6 months after surgery.The multivariate logistic regression analysis revealed that the facial nerve adhesion to tumor,the tumor volume,and the enlargement of IAC were the independent risk factors of facial nerve injury 7 days after vestibular schwannoma surgery.The ROC curve showed that the cut-off points of the tumor volume and enlargement of I AC were 11.25 cm3 and 1.815 respectively.When the cut-off points were exceeded,the possibility of facial nerve injury would largely increase.Conclusion With the growth of the tumor volume,the facial nerve adhesion to tumor,and the enlargement of IAC,the possibility of facial nerve injury after the vestibular schwannoma surgery would accordingly increase.There is no risk factors were found with the facial nerve function recovery at 6 months after surgery.PART2 Identification of Potential Gene Markers and Pathogenesis in NF2 through Bioinformatics AnalysisObject Identification of potential gene markers and pathogenesis in NF2 through bioinformatics analysis.Method Through GEO,we download open data GSE141801.Through differential analysis of the two sets of data,differentially expressed genes(DEGs)were obtained.Enrichment analysis of DEGs,looking for pathways and functions that may be related to disease.Use STRING to construct a differential protein interaction network,screen for Hub Genes,and perform enrichment analysis on key genes.Results A total of 415 DEGs were obtained in this study,of which 132 were upregulated genes and 283 were down-regulated genes.The GO analysis of DEGs is mainly enriched in transmembrane signal receptor activity,receptor ligand activity,chemotactic activity regulation,and cell activation regulation.KEGG analysis showed that it was mainly enriched in cell adhesion molecule signal pathway,phospholipase D signal pathway,and melanoma signal pathway.GSEA analysis showed that it was mainly enriched in calcium signaling pathways.A String web tool was used to build a PPI network with 411 nodes and 1153 edges.After screening,we obtained 20 Hub Genes,of which EGFR and CDKN2A may be closely related to the occurrence of NF2.Conclusion EGFR and CDKN2A may be closely related to the occurrence and development of NF2,SNAP25,GFAP,C3AR1,CDH2 and NF2 may have a certain relationship,which provides new ideas for the future research of NF2.