Analysis of the effect of different facial nerve managements applied to tumor resection in the jugular foramen region
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摘要: 目的 总结不同面神经处理方式应用于颈静脉孔区肿瘤切除术的效果。方法 回顾分析2015年1月至2023年3月接受手术的54例颈静脉孔区肿瘤患者的临床资料, 其中男18例, 女36例; 年龄21~67岁, 平均44.4岁; 随访时间中位数12个月。应用House-Brackmann(HB)分级系统评估患者术前、术后1~2周和末次随访的面神经功能(HBⅠ~Ⅱ级为功能良好): 术前HBⅠ~Ⅱ级42例; 分别采用面神经部分移位术(9例)、面神经完全移位术(28例)、面神经切断再重建术(17例)(Ⅰ期或Ⅱ期)。分析影响术后面神经功能的相关因素。结果 术后病理证实副神经节瘤39例, 神经鞘瘤9例, 3例脑膜瘤, 纤维黏液样肉瘤、软骨肉瘤、血管内肌纤维瘤各1例。面神经部分移位术后面神经功能HBⅠ~Ⅱ级89%(8/9);面神经完全移位术后HBⅠ~Ⅱ级86%(24/28)28例; 面神经切断再重建术后HBⅠ~Ⅱ级分别为2/7(Ⅰ期)和0/3(Ⅱ期)。面神经移位患者中肿瘤的大小及手术方式与术后面神经功能相关(P < 0.05)。面神经完全移位术和部分移位术后面神经功能差异无统计学意义(P>0.05)。结论 术中对面神经的牵拉可能是影响颈静脉孔区肿瘤外科治疗过程中面神经功能的重要因素; 对于面神经离断的患者, 应根据情况采取相应的面神经重建方式, 争取面神经功能的恢复。Abstract: Objective To summarize the results of different facial nerve management modalities applied to tumor resection in the jugular foramen region.Methods The clinical data of 54 patients with tumors in the jugular foramen region who underwent surgery from January 2015 to March 2023 were retrospectively analyzed: 18 males and 36 females; Age ranges from 21 to 67 years, with an average age of 44.4 years; and median follow-up time: 12 months. The House-Brackmann(HB) grading system was applied to assess the patients' facial nerve function before surgery, 1-2 weeks after surgery and at the final follow-up (HBⅠ-Ⅱ grade for good function): 42 cases with preoperative HB grades Ⅰ-Ⅱ; partial facial nerve transposition(9 cases), complete facial nerve transposition(28 cases), and facial nerve excision and re-construction(17 cases) were used, respectively(stage Ⅰor Ⅱ). Relevant factors affecting postoperative facial nerve function were analyzed.Results Postoperative pathology confirmed 39 cases of paraganglioma, 9 cases of nerve sheath tumor, 3 cases of meningioma, and 1 case each of fibromucinous sarcoma, chondrosarcoma, and intravascular myofibroma. Facial nerve function after partial facial nerve transposition was HB grade Ⅰ-Ⅱ in 89%(8/9); after complete facial nerve transposition was HB grade Ⅰ-Ⅱ in 86%(24/28) in 28 cases; after facial nerve severance and reconstruction was HB grade Ⅰ-Ⅱ in 2/7(Stage Ⅰ) and 0/3(Stage Ⅱ), respectively. Tumor size and surgical approach were correlated with postoperative facial nerve function in patients with facial nerve transposition(P < 0.05). There was no statistically significant difference in facial nerve function after complete and partial facial nerve transposition(P>0.05).Conclusion Intraoperative stretching of the facial nerve may be an important factor affecting facial nerve function during surgical treatment of tumors in the jugular venous foramen region; for patients with facial nerve dissection, facial nerve reconstruction should be adopted according to the situation, aiming at the recovery of facial nerve function.
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表 1 颈静脉孔区肿瘤患者基本资料
项目 面神经移位组 面神经切断组 例数 37 17 平均年龄/岁 46.3
(21.0~66.0)40.2
(29.0~67.0)男︰女/例 10︰27 8︰9 平均肿瘤大小/cm 3.1(1.4~7.4) 3.4(2.2~5.1) 中位随访时间/月 12 20 病理类型/例 副神经节瘤 27 12 神经鞘瘤 8 1 脑膜瘤 2 1 其他 0 3 手术方式/例 IFTA 26 8 IFTA+IFTB 6 8 颈部-乳突进路咽旁颅底肿物切除术 5 1 术前面神经功能/例(%) 良好 37(100.0) 5(29.4) 不良 0 12(70.6) 术后短期面神经功能/例(%) 良好 9(24.3) 1(5.9) 不良 28(75.7) 16(94.1) 术后长期面神经功能/例(%) 良好 32(86.5) 2(11.8) 不良 5(13.5) 15(88.2) 其他病理类型中包含纤维黏液样肉瘤、软骨肉瘤、血管内肌纤维瘤。 
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表 2 面神经完全移位组与部分移位组资料比较
例 项目 完全移位组
(n=28)部分移位组
(n=9)P 肿瘤大小 0.101 ≤2 cm 12 1 >2~≤4 cm 12 4 >4 cm 4 4 病理类型 0.204 副神经节瘤 22 5 神经鞘瘤 4 4 脑膜瘤 2 0 术后短期面神经功能 0.705 良好 10 4 不良 18 5 术后长期面神经功能 1.00 良好 23 8 不良 5 1
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表 3 移位组术后长期面神经功能良好与功能不良情况比较
例 项目 总计 功能良好 功能不良 P 手术方式 0.042 IFTA 26 24 2 IFTA+IFTB 6 3 3 颈部-乳突进路咽旁颅底肿物切除 5 4 1 肿瘤大小 0.011 ≤2 cm 13 13 0 >2~≤4 cm 16 14 2 >4 cm 8 4 4 病理类型 0.274 副神经节瘤 27 23 3 神经鞘瘤 8 6 2 脑膜瘤 2 1 1
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表 4 面神经切断组术前、术后面神经功能比较
例 分组 术前面神经功能 术后长期面神经功能 Ⅰ期重建(n=7) HB Ⅰ~Ⅱ级 3 2 HB Ⅲ~Ⅵ级 4 5 Ⅱ期重建(n=3) HB Ⅰ~Ⅱ级 1 0 HB Ⅲ~Ⅵ级 2 3 未重建(n=7) HB Ⅰ~Ⅱ级 1 0 HB Ⅲ~Ⅵ级 6 7 未重建组患者术后长期面神经功能分级均为HB Ⅵ级。
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