What Really Decides the Facial Function of Vestibular Schwannoma Surgery?
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objectives. To find the main cause of facial nerve dysfunction in vestibular schwannoma (VS) surgery and review the prognosis of facial function in relation to tumor size, preoperative facial function and surgical approach. Methods. We reviewed the surgical outcome of 134 patients with VS treated in our department between 1994 and 2008. All patients included in the study had postoperative facial paralysis after surgical management of their VS. There were 14 women and 7 men. The mean age was 48.5 years, with a mean follow-up period of 57 months. Results. Twenty-one patients (sustained facial palsy, 4; newly developed facial palsy, 17) had facial nerve paralysis after surgery:ten patients in large VS and eleven patients in small VS. In large VS group, 4 patients had facial nerve function of HB grade II, 3 patients had HB grade III, and 3 patients had HB grade IV. In small VS group, 9 patients had HB grade II and 2 patients had HB grade IV. Middle cranial fossa approach rather than translabyrinthine approach for the preservation of hearing, led to facial nerve deterioration and the patients who had facial nerve paralysis perioperatively,had resulted in permanent facial paralysis. Conclusion. The tumor size in VS is certainly one of the most important prognostic factors. However, VS tumor size alone should not be considered a unique prognostic indicator. The surgical approach used, which may be related to tumor size, based on the surgeon’s experience, can be a deciding factor, and the status of the facial nerve injured by the tumor can influence postoperative facial nerve function.
Abstract
Objectives. To find the main cause of facial nerve dysfunction in vestibular schwannoma (VS) surgery and review the prognosis of facial function in relation to tumor size, preoperative facial function and surgical approach. Methods. We reviewed the surgical outcome of 134 patients with VS treated in our department between 1994 and 2008. All patients included in the study had postoperative facial paralysis after surgical management of their VS. There were 14 women and 7 men. The mean age was 48.5 years, with a mean follow-up period of 57 months. Results. Twenty-one patients (sustained facial palsy, 4; newly developed facial palsy, 17) had facial nerve paralysis after surgery:ten patients in large VS and eleven patients in small VS. In large VS group, 4 patients had facial nerve function of HB grade II, 3 patients had HB grade III, and 3 patients had HB grade IV. In small VS group, 9 patients had HB grade II and 2 patients had HB grade IV. Middle cranial fossa approach rather than translabyrinthine approach for the preservation of hearing, led to facial nerve deterioration and the patients who had facial nerve paralysis perioperatively,had resulted in permanent facial paralysis. Conclusion. The tumor size in VS is certainly one of the most important prognostic factors. However, VS tumor size alone should not be considered a unique prognostic indicator. The surgical approach used, which may be related to tumor size, based on the surgeon’s experience, can be a deciding factor, and the status of the facial nerve injured by the tumor can influence postoperative facial nerve function.
참고문헌 (20)
- House WF, "Acoustic neuroma: case summaries", Arch Otolaryngol, 88(6), pp.586~591 (1968)
- Gormley WB, "Acoustic neuromas: results of current surgical management", Neurosurgery, 41(1), pp.50~58 (1997)
- Koos WT, "Microsurgery versus radiosurgery in the treatment of small acoustic neurinomas", Acta Neurochir Suppl, 63, pp.73~80 (1995)
- Briggs RJ, "Translabyrinthine removal of large acoustic neuromas", Neurosurgery, 34(5), pp.785~790 (1994)
- 정신, "Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas", SURGICAL NEUROLOGY, 53(4), pp.370~377, ELSEVIER SCIENCE INC
- Wiet RJ, "Long-term results of the first 500 cases of acoustic neuroma surgery", Otolaryngol Head Neck Surg, 124(6), pp.645~651 (2001)
- McElveen JT Jr, "A review of facial nerve outcome in 100 consecutive cases of acoustic tumor surgery", Laryngoscope, 110(10 Pt 1), pp.1667~1672 (2000)
- Kanzaki J, "Results of questionnaires of reporting system, In Acoustic neuroma: consensus on systems for reporting results", pp.183~192 (2003), Springer
- House JW, "Facial nerve grading system", Otolaryngol Head Neck Surg, 93(2), pp.146~147 (1985)
- Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma), "American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC", Otolaryngol Head Neck Surg, 113(3), pp.179~180 (1995)
- Chen TC, "Acoustic neuromas: translabyrinthine approach, In Brain surgery: complication avoidance and management", pp.1772~1800 (1993), Churchill Livingstone
- House WF, "Translabyrinthine approach, In Acoustic tumors: vol. 2. management", pp.43~87 (1979), University Park Press
- 이원상, "New method of identifying the internal auditory canal as seen from the middle cranial fossa approach", ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 115(6), pp.457~460
- Lee HK, "Microsurgical anatomy of the perigeniculate ganglion area as seen from the middle cranial fossa approach", Ann Otol Rhinol Laryngol, 112(6), pp.531~533 (2003)
- Buchman CA, "The learning curve for acoustic tumor surgery", Laryngoscope, 106(11), pp.1406~1411 (1996)
- Tos M, "Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size", Acta Otolaryngol Suppl, 452, pp.38~51 (1988)
- Wanibuchi M, "Hearing preservation in surgery for large vestibular schwannomas", J Neurosurg, 111(4), pp.845~854 (2009)
- Isaacson B, "Facial nerve outcomes in middle cranial fossa vs translabyrinthine approaches", Otolaryngol Head Neck Surg, 133(6), pp.906~910 (2005)
- Bennett M, "Surgical approaches and complications in the removal of vestibular schwannomas", Otolaryngol Clin North Am, 40(3), pp.589~609 (2007)
- Kim J, "Useful surgical techniques for facial nerve preservation in tumorous intra-temporal lesions", Auris Nasus Larynx, 37(1), pp.33~41