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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (04) : 216 -221. doi: 10.3877/cma.j.issn.2095-9141.2023.04.004

临床研究

Koos3、4级前庭神经鞘瘤在桥小脑角区的生长方向对面神经功能的影响
盛成俊, 沈宇晟, 李彦东, 贺诗茹, 吴徐超, 赵小玉, 曾加, 麦麦提力·米吉提, 更·党木仁加甫, 朱国华†()   
  1. 830000　乌鲁木齐，新疆医科大学第一附属医院神经外科
  • 收稿日期:2023-01-13 出版日期:2023-08-15
  • 通信作者: 朱国华

Effect of growth direction of Koos grade 3 and 4 vestibular schwannoma in the pontocerebellar horn region on facial nerve function

Chengjun Sheng, Yusheng Shen, Yandong Li, Shiru He, Xuchao Wu, Xiaoyu Zhao, Jia Zeng, Mijiti Maimaitili·, Dangmurenjiafu Geng·, Guohua Zhu†()   

  1. Department of Neursurgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
  • Received:2023-01-13 Published:2023-08-15
  • Corresponding author: Guohua Zhu
  • Supported by:
    Xinjiang Key Laboratory of Neurosurgical System Diseases Research Open Project Fund(XJDX1711-2206)
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盛成俊, 沈宇晟, 李彦东, 贺诗茹, 吴徐超, 赵小玉, 曾加, 麦麦提力·米吉提, 更·党木仁加甫, 朱国华. Koos3、4级前庭神经鞘瘤在桥小脑角区的生长方向对面神经功能的影响[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 216-221.

Chengjun Sheng, Yusheng Shen, Yandong Li, Shiru He, Xuchao Wu, Xiaoyu Zhao, Jia Zeng, Mijiti Maimaitili·, Dangmurenjiafu Geng·, Guohua Zhu. Effect of growth direction of Koos grade 3 and 4 vestibular schwannoma in the pontocerebellar horn region on facial nerve function[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(04): 216-221.

目的

探讨Koos3、4级前庭神经鞘瘤（VS）在桥小脑角（CPA）区的生长方向与术后面神经功能的关系。

方法

回顾性分析新疆医科大学第一附属医院神经外科自2020年9月至2022年5月收治的电生理监测下行乙状窦后入路切除的55例Koos3、4级VS患者的临床资料。测量所有患者肿瘤内听道轴前部及后部的最大距离A及P，计算P/A比值以及肿瘤最大直径B。采集患者术后早期（2周）、术后远期（6个月）的House-Brackmann（H-B）面神经功能分级评分，根据H-B分级将患者分为良好组和不良组，分析患者术后面神经功能的影响因素。

结果

本组55例VS患者中，48例（87.3%）全切，其中1例未解剖保留面神经；2例（3.6%）近全切；5例（9.1%）次全切。术后2周，良好组32例（58%），不良组23例（42%）。术后6个月，良好组38例（69%），不良组17例（31%）。多因素分析结果显示，P/A是VS患者术后早期及远期面神经功能的独立影响因素（P<0.05）。

结论

Koos3、4级VS在CPA区生长方向是术后面神经功能的独立预测因素，P/A比值越大及A值越小，患者术后面神经功能良好概率越大。

关键词: Koos3、4级前庭神经鞘瘤, 桥小脑角, 生长方向, 面神经功能, 乙状窦后入路
Objective

To investigate the relationship between the growth direction of Koos grade 3 and 4 vestibular schwannoma (VS) in the cerebellopontine angle (CPA) area and postoperative facial nerve function.

Methods

A retrospective analysis was conducted on the clinical data of 55 Koos grade 3 and 4 VS patients who underwent posterior sigmoid approach resection under electrophysiological monitoring and were admitted to Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from September 2020 to May 2022. The maximum distances A and P of the anterior and posterior parts of the internal auditory canal axis of the tumor were measured, and the P/A ratio was calculated, as well as the maximum diameter of the tumor B. The House Brackmann (H-B) facial nerve function grading scores were collected from patients in the early postoperative period (2 weeks) and in the long postoperative period (6 months). According to the H-B grading, the patients' facial nerve function was divided into good group and bad group. The relationship between the influencing factors and postoperative facial nerve function was analyzed.

Results

Among the 55 VS patients in this group, 48 cases (87.3%) underwent total resection, of which 1 case did not dissect and preserve the facial nerve; 2 cases (3.6%) underwent subtotal resection, and 5 cases (9.1%) underwent subtotal resection. Two weeks after surgery, 32 cases (58%) had good facial nerve function and 23 cases (42%) had poor facial nerve function. Six months after surgery, 38 cases (69%) had good facial nerve function and 17 cases (31%) had poor facial nerve function. The results of multivariate analysis showed that P/A was an independent influencing factor for early and long-term facial nerve function in VS patients after surgery (P<0.05).

Conclusion

The growth direction of Koos grade 3 and 4 VS in CPA is an independent predictor of postoperative neurological function, and the greater the P/A ratio and the smaller the A value, the greater the probability of good postoperative facial nerve function in patients.

Key words: Koos grade 3 and 4 vestibular schwannoma, Cerebellopontine angle, Growth direction, Facial nerve function, Posterior approach to the sigmoid sinus
图1 前庭神经鞘瘤影像学及术中术后观察资料A：术前CT示左侧内听道呈喇叭口样扩张；B：术前增强MRI轴位示左侧桥小脑角区可见类圆形近似均匀强化占位，边界规则，脑干及第四脑室受压变形，属于Koos分级4级；C：术前MRI轴位示内听道3D薄层T2序列，沿内听道轴划线C，分别在肿瘤前部及后部做垂直于C线的最大直径A及P；D：术中使用主动刺激电极刺激面神经，面神经解剖保留；E：神经内镜下可见内听道内无肿瘤残留，颅神经解剖保留；F：显微镜下分离肿瘤与神经粘连，保留包绕肿瘤的膜性结构；G~H：术后增强MRI轴位（G）及冠状位（H）示肿瘤全切
Fig.1 Imaging and intraoperative and postoperative observation data of vestibular schwannoma
表1 2组患者术后早期及远期的面神经功能比较
Tab.1 Comparison of facial nerve function between two groups in the early and long-term after surgery
项目 术后早期 术后远期
良好组（n=32） 不良组（n=23) t/χ2值 P值 良好组（n=38） 不良组（n=17） t/χ2值 P值
A（cm，±s） 0.69±0.19 1.28±0.37 -8.145 <0.001 0.76±0.25 1.33±0.41 -6.222 <0.001
P（cm，±s） 2.08±0.71 2.35±0.88 -1.230 0.224 2.05±0.68 2.51±0.93 -2.009 0.050
P/A（±s） 3.05±0.91 1.89±0.68 6.285 <0.001 2.82±0.95 1.99±0.88 3.762 <0.001
B（cm，±s） 3.06±0.87 3.85±1.03 -3.198 0.002 3.09±0.85 4.07±1.03 -3.686 0.001
年龄（岁，±s） 47.53±11.83 50.70±10.99 -1.100 0.276 47.29±11.77 52.35±10.33 -1.644 0.106
囊实性（%）     0.079 0.779     0.455 0.500
囊性 8（61.5） 5（38.5）     8（61.5） 5（38.5）    
实性 24（57.1） 18（42.9）     30（71.4） 12（28.6）    
表2 多因素Logistic回归分析面神经功能的影响因素
Tab.2 Multivariate Logistic regression analysis of the influencing factors of facial nerve function
项目 术后早期 术后远期
标准误 Wald值 OR值 95%CI P值 标准误 Wald值 OR值 95%CI P值
P/A 5.623 8.313 0.001 0.000~0.128 0.005 1.715 8.140 0.106 0.023~0.488 0.004
B 5.033 4.099 17.706 0.807~388.548 0.068 4.033 1.549 3.616 0.434~30.113 0.235
年龄 3.018 0.479 1.075 0.934~1.237 0.312 1.998 2.62 1.075 0.993~1.165 0.075
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