| Object:To explore the risk factors related to nerve function after microsurgical resection of acoustic neuroma,the aim is to find the relevant parameters which could predict the facial nerve function after operation and the operative techniques and strategies which are beneficial to preserve facial nerve function.so as to provide reference for the surgeon to preserve the facial nerve function after acoustic neuroma operation.Materials and Methods:Retrospective analysis of the clinical data of 71 patients with acoustic neuroma from January 2017 to December 2019 in ninth ward of neurosurgery in Tianjin Huanhu Hospital.ALL the patients were operated by the same neurosurgeon Dr.Wang Hong.Moreover,lateral prone position、neurophysiological monitoring and Suboccipital retrosigmoid approach were used to each patients,except one patient with recurrent tumor involving the middle cranial fossa adopt posterior sigmoid sinus combined with inferior temporal approach.we collected all the patient’s sex,age,tumor side,course of disease,tumor diameter and texture,clinical symptoms.Facial nerve function were eveluateed by the surgeon at the time of discharge,half a year,one year and two years according to House-Brackmann(HB)facial nerve grading system(appendix 1).All the variable were conducted to explore possible predictors of postoperative nerve function and surgical techniques and strategies beneficial for protecting facial nerve function.Result:This study reviewed and analyzed 71 cases,2 of which were not included in the facial nerve function study because the preoperative facial nerve function H-B grade were IV/VI.Of these patients,37 were men and 34 were women;the average age was 51.8 years(23-72 years);The maximum diameter of tumor was 1.5-5.6 cm(3.06±1.10 cm);46 cases on the right side and 25 cases on the left side;9 cases were cystic and 62 cases were non-cystic;the rates of total tumor resection,near total resection and secondary total resection were 31.9%,31.9% and 36.2%,respectively.47 cases were followed up for more than 1 year,24 cases for more than 2 years,and no missing cases were visited.In this group,The rate of facial nerve anatomic preservation was 100%.At the time of discharge,there were 49 cases(71.0%)of facial nerve function H-B grade I/II,13 cases(18.9%)of in grade III,and 7 cases(10.1%)in grade H-B.The follow-up ranged from 1 week to 2 years,at the end of the follow-up,64 cases(92.8%)were H-B grade I/II,1 case(1.4%)was HB III,and 4 cases(5.8%)were H-B grade IV-VI.There were 0 cases,11 cases,33 cases,14 cases and 13 patients in grade 0,grade 1,grade 2,grade 3 and grade 4 according to the multidisciplinary consensus grading standard of Japanese Acoustic Neuroma.The neurological conditions of postoperation in each grade group were counted(P=0.037<0.05).The H-B I/II grade of cystic acoustic neuroma was 6,and non-cystic patients was 58.By using the non-parametric test analysis method,P=0.002<0.05.There was no significant correlation between tumor resection degree,course of disease and postoperative nerve function.Conclusion:1 Electrophysiological assisted resection of acoustic neuroma via the posterior approach of suboccipital sigmoid sinus in the lower prone position is a safe and effective surgical approach;2 The postoperative facial nerve function showed a trend of gradual improvement over time during 1-2 years after operation;3 The size of tumor diameter can be used as a predictor of postoperative nerve function;4 The facial nerve function after cystic tumor surgery is worse than non-cystic tumor;5 It is not recommended that poor postoperative nerve function be used at the expense of perfect tumor resection;6 Different neurosurgeon should make more individualized treatment plan according to their own technology,operating room infrastructure,tumor size,tumor texture and patient’s occupation and will. |
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