| Objective: To analyze the clinical features of 60 cases of acoustic neuroma patients, study in preservation of facial nerve with neurophysiological monitoring and related factors influencing long-term facial nerve function.Method: A retrospective analysis of 60 patients who was diagnosed with acoustic neuroma was admitted in the First Hospital of Jilin University in June 2012 to January 2016. The patients in this group had operations by associate professors and senior neurosurgeons. All neuromas are unilateral and all operations did intraoperative neurophysiological monitoring by the same physician. 1 weeks, 6 months and 1 years of facial nerve function was evaluated in all patients according to the House-Brackmann classification standard of facial nerve function before and after operation. The general information and clinical manifestations of all patients were recorded. The results were statistically analyzed by SPSS 20.0Result: In this study, the implementation of acoustic neuroma resection in 60 cases, all patients were treated by retrosigmoid approach for tumor resection. Hearing loss in 30 patients(50%), facial numbness in15 patients(25%), headache in 14 patients(23.3%), tinnitus in 10(16.7%), facial pain in 6 patients(10%), dizziness in 4(6.7%), and other symptoms in 4 patients(6.7%). Tumor less than 2cm in 2 cases(3.3%),2-3cm(including 2, 3cm) 35 cases(58.3%), greater than 3cm in 23 cases(38.4%). Total resection was performed in 57 cases(95%), subtotal resection in 2 cases(3.3%), partial resection in 1 case(1.7%). In 60 cases,51 cases(85%) of complete anatomical preservation of facial nerve,partial retention of total 8 cases(13.3%). Intraoperative situation is unknown, 1 case(1.7%) can not determine whether to be retained in.According to the House-Brackmann classification standard of facial nerve function, 49 cases of preoperative facial nerve function assessment for H-B in front of I grade, 8 cases of grade II, 3 cases of grade III. After1 weeks to assess the results of H-B, I grade 7 cases, II grade 14 cases, 30 cases of grade III, IV grade 7 cases, 2 cases of grade V. Evaluation 6months after the operation, H-B I grade 12 cases, 19 cases of grade II, III grade 21 cases, 5 cases of grade IV, 1 cases of grade V. After 1 years of assessment, H-B I grade 7 cases, II 21 cases, III grade 13 cases, 10 cases of grade IV. H-B facial nerve grading 1 years respectively and statistical different tumor size, patient age and duration of symptoms in patients with the postoperative. The results by statistical test for linear trend analysis. The results showed that the hearing in patients with acoustic neuroma tumor size and operation after 1 year in patients with facial nerve function reserved between linear correlation(P < 0.05). Thepatient’s age and duration of symptoms with preservation of facial nerve function has no obvious correlation(P > 0.05).Conclusion: The patients with acoustic neuroma with intraoperative neurophysiological monitoring, under the posterior sigmoid sinus approach to resect tumor, can obtain a better preservation of facial nerve.The tumor size of patients with acoustic neuroma and postoperative facial nerve function of patients with reserved have a linear correlation, namely the larger tumor diameter is, the lower the degree of retention of the long-term facial nerve function after operation, patients with facial nerve H-B grading will increasingly high. Conversely, the smaller tumor diameter is, the higher the degree of retention of the long-term facial nerve function after operation, patients with facial nerve H-B grading will lower. There was no significant correlation between the age factor of the patient and the duration of symptom and the retention of facial nerve function in 1 years after operation. |
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