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

doi:10.3877/cma.j.issn.2095-9141.2023.04.004

Abstract

Abstract:

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

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.

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References 25

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项目	术后早期				术后远期
项目	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）

项目	术后早期				术后远期
项目	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）

项目	术后早期					术后远期
项目	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

项目	术后早期					术后远期
项目	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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